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'''Topical steroids''' are the topical forms of [[corticosteroids]]. Topical steroids are the most commonly prescribed topical medications for the treatment of rash, eczema, and dermatitis. Topical steroids have antiinflammatory properties, and are classified based on their vasoconstriction abilities.<ref>Habif, T.P. Clinical Dermatology. 1990. Mosby. p. 27</ref> There are numerous topical steroid products. All the preparations in each class have the same antiinflamatory properties, but essentially differ in base, and price.
'''Topical steroids''' are the topical forms of [[corticosteroids]]. Topical steroids are the most commonly prescribed topical medications for the treatment of rash, eczema, and dermatitis. Topical steroids have antiinflammatory properties, and are classified based on their vasoconstriction abilities.<ref name=Habif_27>{{cite book |author=Habif, Thomas P. |title=Clinical dermatology: a color guide to diagnosis and therapy |publisher=Mosby |location=St. Louis |year=1990 |page=27 |isbn=0-8016-2465-7 |edition=2nd}}</ref> There are numerous topical steroid products. All the preparations in each class have the same antiinflamatory properties, but essentially differ in base, and price.


== History ==
== History ==
Corticosteroids were first made available for general use around 1950.<ref name="pmid13260925">{{cite journal |author=RATTNER H |title=The status of corticosteroid therapy in dermatology |journal=Calif Med |volume=83 |issue=5 |pages=331–5 |year=1955 |month=November |pmid=13260925 |pmc=1532588 |doi= |url=}}</ref>
Corticosteroids were first made available for general use around 1950.<ref name="pmid13260925">{{cite journal |author=Rattner H |title=The status of corticosteroid therapy in dermatology |journal=Calif Med |volume=83 |issue=5 |pages=331–5 |year=1955 |month=November |pmid=13260925 |pmc=1532588 }}</ref>


== How to choose a steroid ==
== How to choose a steroid ==
The best result is obtained when the correct strength is matched with a specific diagnosis and anatomic location. Essentially, weaker topical steroids are utilized for thin-skinned and sensitive areas, especially areas under occlusion (armpit, groin, buttock crease, breast folds). Weaker steroids are used on the face, eyelids, diaper area, perianal skin, and intertrigo of the groin or body folds. Moderate steroids are used for atopic dermatitis, nummular eczema, asteatotic dermatitis, lichen sclerosis et atrophicus of the vulva, scabies (after scabiecide), severe dermatitis. Strong steroids are used for psoriasis, lichen planus, discoid lupus, chapped feet, lichen simplex chronicus, severe poison ivy, alopecia areata, nummular eczema, and severe atopic dermatitis in adults.<ref>Habif, T.P. Clinical Dermatology. 1990. Mosby. p 27.</ref>
The best result is obtained when the correct strength is matched with a specific diagnosis and anatomic location. Essentially, weaker topical steroids are utilized for thin-skinned and sensitive areas, especially areas under occlusion (armpit, groin, buttock crease, breast folds). Weaker steroids are used on the face, eyelids, diaper area, perianal skin, and intertrigo of the groin or body folds. Moderate steroids are used for atopic dermatitis, nummular eczema, asteatotic dermatitis, lichen sclerosis et atrophicus of the vulva, scabies (after scabiecide), severe dermatitis. Strong steroids are used for psoriasis, lichen planus, discoid lupus, chapped feet, lichen simplex chronicus, severe poison ivy, alopecia areata, nummular eczema, and severe atopic dermatitis in adults.<ref name=Habif_27/>


== How to use a topical steroid ==
== How to use a topical steroid ==
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Strong topical steroids are used in limited skin areas to minimize systemic side effects. They are indicated for thick-skinned areas like the palms, soles of feet, and certain dermatitis such as [[lichen planus]] and [[psoriasis]] of the limbs.
Strong topical steroids are used in limited skin areas to minimize systemic side effects. They are indicated for thick-skinned areas like the palms, soles of feet, and certain dermatitis such as [[lichen planus]] and [[psoriasis]] of the limbs.


Long-term use of topical steroids can lead to secondary infection with fungus or bacteria (see [[tinea incognito]]), skin atrophy, [[telangiectasia]] (prominent blood vessels), skin bruising and fragility.<ref>Habif, T.P. Clinical Dermatology. 1990. Mosby. p 27-30.</ref>
Long-term use of topical steroids can lead to secondary infection with fungus or bacteria (see [[tinea incognito]]), skin atrophy, [[telangiectasia]] (prominent blood vessels), skin bruising and fragility.<ref>{{cite book |author=Habif, Thomas P. |title=Clinical dermatology: a color guide to diagnosis and therapy |publisher=Mosby |location=St. Louis |year=1990 |pages=27–30 |isbn=0-8016-2465-7 |edition=2nd}}</ref>


The use of the [[Finger tip unit]] may be helpful in guiding how much topical steroid is required to cover different areas of the body.
The use of the [[Finger tip unit]] may be helpful in guiding how much topical steroid is required to cover different areas of the body.


==Side effects of topical steroids ==
==Side effects of topical steroids ==
* [[Diabetes Mellitus]]<ref>{{cite journal |author=van der Linden MW, Penning-van Beest FJ, Nijsten T, Herings RM |title=Topical corticosteroids and the risk of diabetes mellitus: a nested case-control study in the Netherlands |journal=Drug Saf |volume=32 |issue=6 |pages=527–37 |year=2009 |pmid=19459719 |url=http://content.wkhealth.com/linkback/openurl?issn=0114-5916&volume=32&issue=6&spage=527}}</ref>
* [[Diabetes Mellitus]]<ref>http://www.ncbi.nlm.nih.gov/pubmed/19459719?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum</ref>
* [[Osteoporosis]]
* [[Osteoporosis]]
* Allergic contact dermatitits (see [[steroid allergy]])
* Allergic contact dermatitits (see [[steroid allergy]])
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* [[Perioral dermatitis]]: This is a rash that occurs around the mouth and the eye region that has been associated with topical steroids.
* [[Perioral dermatitis]]: This is a rash that occurs around the mouth and the eye region that has been associated with topical steroids.
* Ocular effects: Topical steroid drops are frequently used after eye surgery but can also raise [[intra-ocular pressure]] (IOP).
* Ocular effects: Topical steroid drops are frequently used after eye surgery but can also raise [[intra-ocular pressure]] (IOP).
* [[Tachyphylaxis]]: The acute development of tolerance to the action of a drug after repeated doses.<ref>Wolverton et al. Comprehensive dermatologic drug therapy. pp. 562–563.</ref> Significant tachyphylaxis can occur by day 4 of therapy. Recovery usually occur after 3 to 4 days rest. This has led to therapies such as 3 days on, 4 days off; or one week on therapy, and one week off therapy.
* [[Tachyphylaxis]]: The acute development of tolerance to the action of a drug after repeated doses.<ref>{{cite book |author=Wolverton, Stephen E. |title=Comprehensive Dermatologic Drug Therapy |publisher=W.B. Saunders Company |location=Philadelphia, PA |year=2001 |pages=562–3 |isbn=0-7216-7728-2 }}</ref> Significant tachyphylaxis can occur by day 4 of therapy. Recovery usually occur after 3 to 4 days rest. This has led to therapies such as 3 days on, 4 days off; or one week on therapy, and one week off therapy.
*[[Cream (pharmaceutical)|Vehicle]]-related adverse effects
*[[Cream (pharmaceutical)|Vehicle]]-related adverse effects
*Other local adverse effects: These include facial [[hypertrichosis]], [[folliculitis]], [[miliaria]], genital ulceration, and [[granuloma gluteale infantum]]. Long term use has resulted in [[Norwegian scabies]], [[Kaposi's sarcoma]], and other unusual [[dermatosis]].<ref>Wolverton, SE. Comprehensive Dermatologic Drug Therapy. WB Saunders, 2001. p. 563.</ref>
*Other local adverse effects: These include facial [[hypertrichosis]], [[folliculitis]], [[miliaria]], genital ulceration, and [[granuloma gluteale infantum]]. Long term use has resulted in [[Norwegian scabies]], [[Kaposi's sarcoma]], and other unusual [[dermatosis]].<ref>{{cite book |author=Wolverton, Stephen E. |title=Comprehensive Dermatologic Drug Therapy |publisher=W.B. Saunders Company |location=Philadelphia, PA |year=2001 |page=563 |isbn=0-7216-7728-2 }}</ref>


== Soft steroids ==<!-- "Soft steroid" redirects here -->
== Soft steroids ==<!-- "Soft steroid" redirects here -->
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{{see also|ATC code D07}}
{{see also|ATC code D07}}
===USA system===
===USA system===
The USA system utilizes 7 classes. Class I is the strongest, or superpotent. Class VII is the weakest and mildest.<ref>Habif, T.P. Clinical Dermatology. 1990. Mosby. Inside of the front cover</ref>
The USA system utilizes 7 classes. Class I is the strongest, or superpotent. Class VII is the weakest and mildest.<ref>{{cite book |author=Habif, Thomas P. |title=Clinical dermatology: a color guide to diagnosis and therapy |publisher=Mosby |location=St. Louis |year=1990 |page=Inside front cover |isbn=0-8016-2465-7 |edition=2nd}}</ref>


====Group I====
====Group I====
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=== The four groups of steroids ===
=== The four groups of steroids ===
The highlighted steroids are often used in the screening of allergies to topical steroid and systemic steroids.<ref>Wolverton, SE. Comprehensive Dermatologic Drug Therapy. WB Saunders, 2001. p. 562</ref> When one is allergic to one group, one is allergic to all steroids in that group.
The highlighted steroids are often used in the screening of allergies to topical steroid and systemic steroids.<ref>{{cite book |author=Wolverton, Stephen E. |title=Comprehensive Dermatologic Drug Therapy |publisher=W.B. Saunders Company |location=Philadelphia, PA |year=2001 |page=562 |isbn=0-7216-7728-2 }}</ref> When one is allergic to one group, one is allergic to all steroids in that group.


====Group A====
====Group A====

Revision as of 13:33, 8 May 2010

Topical steroids are the topical forms of corticosteroids. Topical steroids are the most commonly prescribed topical medications for the treatment of rash, eczema, and dermatitis. Topical steroids have antiinflammatory properties, and are classified based on their vasoconstriction abilities.[1] There are numerous topical steroid products. All the preparations in each class have the same antiinflamatory properties, but essentially differ in base, and price.

History

Corticosteroids were first made available for general use around 1950.[2]

How to choose a steroid

The best result is obtained when the correct strength is matched with a specific diagnosis and anatomic location. Essentially, weaker topical steroids are utilized for thin-skinned and sensitive areas, especially areas under occlusion (armpit, groin, buttock crease, breast folds). Weaker steroids are used on the face, eyelids, diaper area, perianal skin, and intertrigo of the groin or body folds. Moderate steroids are used for atopic dermatitis, nummular eczema, asteatotic dermatitis, lichen sclerosis et atrophicus of the vulva, scabies (after scabiecide), severe dermatitis. Strong steroids are used for psoriasis, lichen planus, discoid lupus, chapped feet, lichen simplex chronicus, severe poison ivy, alopecia areata, nummular eczema, and severe atopic dermatitis in adults.[1]

How to use a topical steroid

To prevent tachyphylaxis, a topical steroid is often prescribed to be used on a week on, week off routine. Some recommend using the topical steroid for 3 consecutive days on, followed by 4 consecutive days off.

Weak topical steroid are reserved for the eyelids, facial skin, body folds, arm pits, groins, genitals, and perianal region.

Moderate topical steroids are used in wider unoccluded parts of the body like the trunk, arms, and legs.

Strong topical steroids are used in limited skin areas to minimize systemic side effects. They are indicated for thick-skinned areas like the palms, soles of feet, and certain dermatitis such as lichen planus and psoriasis of the limbs.

Long-term use of topical steroids can lead to secondary infection with fungus or bacteria (see tinea incognito), skin atrophy, telangiectasia (prominent blood vessels), skin bruising and fragility.[3]

The use of the Finger tip unit may be helpful in guiding how much topical steroid is required to cover different areas of the body.

Side effects of topical steroids

Soft steroids

Soft steroids are topical steroids with a low rate of side effects in relation to their anti-inflammatory potency. These include hydrocortisone aceponate, hydrocortisone buteprate, methylprednisolone aceponate, mometasone furoate and prednicarbate.[8]

Classification systems

See also: ATC code D07

USA system

The USA system utilizes 7 classes. Class I is the strongest, or superpotent. Class VII is the weakest and mildest.[9]

Group I

Very potent: up to 600 times stronger than hydrocortisone.

Group II

Group III

Group IV

Group V

Group VI

Group VII

The weakest class of topical steroids. Has poor lipid permeability, and can not penetrate mucous membranes well.

  • Hydrocortisone 2.5% (Hytone cream, lotion, ointment)
  • Hydrocortisone 1% (Many over-the-counter brands)

Other countries

Most other countries (e.g. the UK, Germany, the Netherlands, New Zealand) recognize only 4 classes.[10]. In New Zealand I is the strongest, while in continental Europe, class IV is regarded as the strongest.

Class IV

Very potent (up to 600 times as potent as hydrocortisone) Clobetasol propionate (Dermovate Cream/Ointment) Betamethasone dipropionate (Diprosone OV Cream/Ointment)

Class III

Potent (50-100 times as potent as hydrocortisone)

Class II

Moderate (2-25 times as potent as hydrocortisone)

  • Clobetasone butyrate (Eumovate Cream)
  • Triamcinolone acetonide (Aristocort Cream/Ointment, Viaderm KC Cream/Ointment, Kenacomb Ointment)

Class I

Mild

  • Hydrocortisone 0.5-2.5% (DermAid Cream/Soft Cream, DP Lotion-HC 1%, Skincalm, Lemnis Fatty Cream HC, Pimafucort Cream/Ointment)

Japan classification

Japan rates topical steroids from 1 to 5, with 1 being strongest.

The four groups of steroids

The highlighted steroids are often used in the screening of allergies to topical steroid and systemic steroids.[11] When one is allergic to one group, one is allergic to all steroids in that group.

Group A

Hydrocortisone, Hydrocortisone acetate, Cortisone acetate, Tixocortol pivalate, Prednisolone, Methyprednisolone, and Prednisone.

Group B

Triamcinolone acetonide, Triamcinolone alcohol, Amcinonide, Budesonide, Desonide, Fluocinonide, Fluocinolone acetonide, and Halcinonide.

Group C

Betamethasone, Betamethasone sodium phosphate, Dexamethasone, Dexamethasone sodium phosphate, and Fluocortolone.

Group D

Hydrocortisone-17-butyrate, Hydrocortisone-17-valerate, Aclometasone dipropionate, Betamethasone valerate, Betamethasone dipropionate, Prednicarbate, Clobetasone-17-butyrate, Clobetasol-17-propionate, Fluocortolone caproate, Fluocortolone pivalate, and Fluprednidene acetate.

References

  1. ^ a b Habif, Thomas P. (1990). Clinical dermatology: a color guide to diagnosis and therapy (2nd ed.). St. Louis: Mosby. p. 27. ISBN 0-8016-2465-7.
  2. ^ Rattner H (1955). "The status of corticosteroid therapy in dermatology". Calif Med. 83 (5): 331–5. PMC 1532588. PMID 13260925. {{cite journal}}: Unknown parameter |month= ignored (help)
  3. ^ Habif, Thomas P. (1990). Clinical dermatology: a color guide to diagnosis and therapy (2nd ed.). St. Louis: Mosby. pp. 27–30. ISBN 0-8016-2465-7.
  4. ^ van der Linden MW, Penning-van Beest FJ, Nijsten T, Herings RM (2009). "Topical corticosteroids and the risk of diabetes mellitus: a nested case-control study in the Netherlands". Drug Saf. 32 (6): 527–37. PMID 19459719.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  5. ^ Atopy Steroid Addicton in Japan
  6. ^ Wolverton, Stephen E. (2001). Comprehensive Dermatologic Drug Therapy. Philadelphia, PA: W.B. Saunders Company. pp. 562–3. ISBN 0-7216-7728-2.
  7. ^ Wolverton, Stephen E. (2001). Comprehensive Dermatologic Drug Therapy. Philadelphia, PA: W.B. Saunders Company. p. 563. ISBN 0-7216-7728-2.
  8. ^ Mutschler, Ernst (2001). Arzneimittelwirkungen (in German) (8 ed.). Stuttgart: Wissenschaftliche Verlagsgesellschaft. p. 723. ISBN 3-8047-1763-2. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  9. ^ Habif, Thomas P. (1990). Clinical dermatology: a color guide to diagnosis and therapy (2nd ed.). St. Louis: Mosby. p. Inside front cover. ISBN 0-8016-2465-7.
  10. ^ http://dermnetnz.org/treatments/topical-steroids.html
  11. ^ Wolverton, Stephen E. (2001). Comprehensive Dermatologic Drug Therapy. Philadelphia, PA: W.B. Saunders Company. p. 562. ISBN 0-7216-7728-2.

See also

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