Desoximetasone: A Breakthrough Treatment for Eczema

Overview:

Desoximetasone is an effective and promising medication for tackling the manifestation associated with eczema, where the person experiences cracked, scaly, and itchy skin patches. The drug regulatory body of the United States, the Food and Drug Administration (FDA), endorsed the usage of Desoximetasone for eczema. Desoximetasone gained FDA authorization in 1977. Different formulations of Desoximetasone are being marketed under various brand names. In addition to eczema, Desoximetasone has proven effective for various other skin conditions.

Drug Group:

Desoximetasone falls under the primary synthetic corticosteroid drug class. These corticosteroids elicit functions that simulate the actions of one of the hormones liberated by the adrenal gland called cortisol. The corticosteroid drug class is specifically known for its potent anti-inflammatory activities that aid in resolving active inflammatory conditions in the body.

Available Doses and Dosage Forms:

• Dosage Forms: Desoximetasone is specifically indicated for topical use, and therefore, it is formulated and marketed in four distinct forms - gel, cream, spray, and ointment.

• Available Doses: It has concentrations ranging from 0.05 to 0.25 percent of the formulations. Gels, cream, and ointment are available in 0.05 percent concentration, where a single gram of the formulation encompasses 0.5 milligrams of active molecules of Desoximetasone. 0.25 percent of Desoximetasone is generally marketed in spray form, in which a single gram of spray formulation contributes 2.5 milligrams of active drug molecules.

For Patients:

What Is Eczema?

Eczema is a frequently encountered skin condition in which the affected person elicits severe scratchiness in the skin area. It is often accompanied by peeling, redness, and rashes. Skin loses its natural plumpiness and moisture. Instead, it always appears dry. The dryness enhances the skin irritation and itchy sensation. Severe scratching of the skin makes it more rough. Skin soreness and cracks often develop over the skin surface. The skin appears flushed, and it gives rise to skin bumps. The synonym atopic dermatitis, a subtype of eczema, is widely known. It is quite a persisting kind of skin condition with periods of breakouts and dormancy.

Eczema is considered a multifactorial skin condition where numerous factors pave the way for eczema. Eczema arises due to exaggerated reactivity of the body’s immune system towards certain external or environmental factors. In addition, certain genes make a person susceptible to developing eczema. A person with a positive family history of the condition will likely develop it. Environmental factors like air quality and smoke can also evoke the precipitation of eczema. Anti-inflammatory medicines work great for eczema. However, it is better advised to identify the triggering factor evoking this skin reaction so that the person can withdraw from those factors to check for flare-ups.

How Does Desoximetasone Work?

Desoximetasone works for eczema by bringing down the inflammatory changes and other troubling manifestations. The mechanism by which Desoximetasone works for eczema needs to be clarified and made more specific. Being a corticosteroid, Desoximetasone is known to trigger and evoke an inhibitory protein that can check the synthesis of bodily substances that facilitate inflammation. Those substances are coined as inflammatory mediators that enhance the inflammatory response by eliciting manifestations like swelling, soreness, itching, and many more.

What Is the Dosage of Desoximetasone?

Desoximetasone's topical composition in cream, gel, and ointment is marketed in 0.05 percent concentration. Being a topical formulation, it has to be rubbed over the affected skin area in the form of a thin film at a daily frequency of two times. It is the most widely preferred dosage of Desoximetasone for tackling eczema.

How Effective Is Desoximetasone?

The efficacy and potency of Desoximetasone have been exposed in various clinical trials, where Desoximetasone was trialed among eczema subjects. The trial results were on par with the other standard medicines for treating eczema. Desoximetasone alleviated manifestations like itching and cracking of the skin. In addition to eczema, it has extended efficacy in dealing with other skin issues eliciting rashes, blisters, and skin bumps.

What Are the Things to Inform the Doctor Before Taking the Drug?

There are a set of things that doctors should be informed of prior. Proper communication with the doctors is imperative for the success of every treatment.

• The doctor should be informed about prior allergic encounters with Desoximetasone or any other medicine belonging to the class of corticosteroids. Hyperreactivity to any of the components present in the topical formulation of Desoximetasone should also be noted, as it can trigger subsequent allergic reactions upon usage.

• The doctor should be provided with a comprehensive medical history of the patient to look for the medicine's safety for that particular patient. Certain underlying medical conditions can harm Desoximetasone. Therefore, the doctor will assess the patient's medical condition and rule out such possibilities. Also, conditions like enhanced blood sugar level and Cushing’s syndrome (enhanced cortisol level) can alter the uptake rate of the topical formulation into the cell, augmenting the risk for side effects.

• In addition to the medical history, it is imperative to disclose the patient’s drug history, encompassing all the dietary supplements and over-the-counter medicines the person had or used to have. This helps the doctor understand the possibility of the drug-to-drug association, which would otherwise impair the effectiveness of either or both medicines. It may even harm the body, potentially hazardous for the patient.

• The pregnancy and lactation status of the patient should be disclosed without fail before initiating the therapy using Desoximetasone. Not all medicines are advisable during pregnancy; certain medicines can impact the baby's growth in the womb. Hence, it is strictly advised to disclose the pregnancy status so that the doctor can analyze the risks and benefits of using Desoximetasone. If the patient is planning for conception shortly, the doctor should be aware of it before the inception of the topical therapy.

How Is Desoximetasone Administered?

Desoximetasone is available in formulations that can be rubbed over the skin surface. These formulations are not intended for oral intake.

• Take out an appropriate quantity of the formulation (gel, cream, or ointment) on the fingertip, then gently put in and stroke over the affected skin area.

• Vigorous rubbing can further damage the eczematous skin, so care should be taken to coat the medicine.

• Only a thin film of the medicine must be coated over the skin. Over-application of Desoximetasone can enhance the side effects, while under-application can remarkably impact the effectiveness.

• After application, the hands should be washed off immediately to check the uptake of the topical formulations into the hands.

• While applying Desoximetasone, care should be taken not to expose the medicine to the mouth, eyes, or other private parts where it is not intended to be applied.

• After application, the applied skin area should be left open unless the concerned doctor advises it. Protecting the skin area with occlusive dressing can enhance the medicine's uptake into the blood, leading to toxicity issues.

What Are the Side Effects of Desoximetasone?

Some of the widely reported side effects concerning the use of Desoximetasone topical formulations include the following:

• Allergic Reactions: Patients undergoing Desoximetasone topical therapy often report sudden skin irritations, intense itching, and flaming sensations with pain and heat over the applied skin area.

• Hair Growth: Atypical and abnormal growth of hair over the applied skin area is manifested in patients who had long-term exposure to topical formulations of Desoximetasone.

• Acneiform Eruptions: The development of acne and other skin bumps are other potential side effects manifested following topical therapy.

• Eczema Breakouts: Though Desoximetasone is advised for tackling the manifestations of eczema, at times, the topical formulation of Desoximetasone itself triggers the condition, leading to a sudden aggravation of the eczematous reactions in the skin. Dryness and prickling sensation add to the worsening of the condition.

• Perioral Dermatitis: Numerous small pinpoint bumps encircling the mouth are also reported following topical Desoximetasone therapy.

• Hypopigmentation: The skin loses its natural color following long-term topical therapy using Desoximetasone. Skin patches with compromised skin color that stand out from the normal skin area create aesthetic concern for the patient.

• Grave Reactions: Extensive development of skin rashes with bleeding areas rarely develop with Desoximetasone. Pus releasing points and bleeding points are indications of severe skin reactions underneath, which entail immediate medical attention.

Dietary Considerations:

No specific dietary instruction must be followed while undergoing Desoximetasone topical therapy. However, each patient's medical condition and health status differ, and the doctors analyze each case individually. The patient will be advised to follow certain dietary instructions favoring treatment processes in such cases.

Missed Dose:

The topical formulations are generally advised to be applied at a daily frequency of two times. It is better to follow a specific period for application throughout the treatment. However, at times, the patient may need to remember to apply at the specified time; in such cases, it is advised to apply once the patient becomes aware of the missed dose. If the patient recalls it only at the time of subsequent application, it is best to skip the missed dose. Do never apply more topical formulations to counterbalance the overlooked dose, which can bring adverse side effects.

Overdose:

Since Desoximetasone is made available in topical formulations, overdose issues can come up with either over-application or frequent application of the medicine. Overdosing can enhance the possibility of adverse reactions on the skin. It can bring severe burning and prickling sensations over the skin. Oral intake of the topical formulation can also bring in potential overdose issues and other systemic complications. In such cases, immediate medical care should be made available to the patient to tackle the overdose issues.

Storage:

Room temperature is ideal for cream, gel, and ointment formulations of Desoximetasone. At the same time, the spray formulation of Desoximetasone needs to be kept under the temperature range of 20 to 25 degrees Celsius (68 to 77 degrees Fahrenheit). All these topical formulations should be protected from exposure to heat, particularly the spray form, as it can catch fire easily. These formulations should be made inaccessible to small kids to check inadvertent ingestion or application of the medicine. Medicines beyond the expiration date should be disposed of as advised by the pharmacist or the medical professional.

For Doctors:

Indications:

• Eczema.

• Psoriasis (plaque type).

• Inflammatory dermatoses.

• Pruritic dermatoses.

Dose:

• Topical formulations like cream, gel, and ointment with a concentration of 0.05 percent are employed for conditions like eczema and other dermatoses, with a daily application frequency of twice.

• For the plaque form of psoriasis, a 0.25 percent formulation of Desoximetasone in spray form is advised with a daily application frequency of two times.

Dosing Considerations:

To keep the dosage consistent, a specific time for topical application of Desoximetasone is always instructed. This ensures that drug concentration in the blood remains consistent throughout the treatment course, which warrants the availability of the medicine in the required concentration in the blood.

What Are the Pharmacological Aspects of Desoximetasone?

• Mechanism: The mechanism behind the action of Desoximetasone is more or less similar to that of other corticosteroids. Desoximetasone elicits its actions through specific properties like anti-pruritic, vasoconstriction, and anti-inflammation. Once Desoximetasone reaches the cellular cytoplasm, it interacts with the cytoplasmic receptor proteins. This interaction results in a steroid-receptor complex, which associates with the genetic material inside the cellular nucleus. This complex alters the transcription process, which enhances the yielding of lipocortin. Lipocortin glycoprotein can influence the functions of an enzyme called phospholipase A2. Major mediators of inflammation are triggered and activated by a specific enzyme called arachidonic acid. Phospholipase A2 is imperative for arachidonic acid formation. The enhanced production of lipocortin exerts an inhibitory effect on the phospholipase A2. Once there is a potent check on phospholipase A2, it gets reflected in the arachidonic acid formation. Thereby eliciting anti-inflammatory actions.

• Pharmacodynamics: Desoximetasone also checks interleukin-1 formation by interacting with the corresponding messenger ribonucleic acid (mRNA). It enhances the immunosuppression and anti-inflammatory properties.

• Pharmacokinetics: Once Desoximetasone is exposed over the skin surface, it is taken up into the cell. The rate of uptake is often guided by certain factors like the integrity of the skin, the vehicle of the topical formulation, the type of topical formulation, and occlusive dressing over the skin surface. Desoximetasone appreciably penetrates the inflamed skin and reaches the systemic circulation. The distribution of the drug is aided by plasma proteins that form complexes. Certain Liver enzymes are responsible for the metabolism and breakdown of the Desoximetasone drug molecules, while the elimination occurs through the kidney. However, biliary excretion is also reported with certain corticosteroids.

Toxicity:

Numerous non-clinical study analyses were conducted to expose the toxicities associated with using topical formulations of Desoximetasone. However, none of the animal studies could establish any mutagenic potential for Desoximetasone. A 13-week animal study with topical Desoximetasone concluded the medicine's potential to precipitate severe immunosuppression and adrenal atrophy. Therefore, long-term exposure to Desoximetasone is likely to influence carcinogenesis. Non-clinical studies failed to demonstrate a safer dose of Desoximetasone with no side effects.

Clinical Studies:

Randomized clinical trials were conducted to evaluate and demonstrate the potency of Desoximetasone in tackling eczema. It was concluded that subjects treated with Desoximetasone exhibited an appreciable downgrading in pruritus compared with other standard topical medicines for eczema. In addition, various post-marketing surveillance studies have validated the efficacy and safety of topical Desoximetasone.

What Are the Contraindications of Desoximetasone?

There are no reports of absolute contraindications for the topical formulation of Desoximetasone. However, patients with a history of hypersensitivity or exaggerated reactivity towards Desoximetasone or any other topical corticosteroid medications are advised to refrain from using Desoximetasone in any form. Similarly, patients with allergic encounters to any of the components present in the topical formulations of Desoximetasone are also advised not to use the medicine.

Warnings and Precautions:

• Glucocorticosteroid Insufficiency: Desoximetasone carries the risk of suppressing the HPA (hypothalamic-pituitary-adrenal) axis, eventually resulting in the manifestations of glucocorticosteroid insufficiency. The effects are more pronounced during the inceptive and terminal stages of Desoximetasone therapy. Hence, periodic assessments should be made to track advancing HPA axis suppression. Certain disease conditions, like diabetes mellitus and Cushing’s syndrome, potentiate systemic exposure to the medicine, which enhances the susceptibility to glucocorticoid insufficiency.

• Allergic Contact Dermatitis: There are chances for the patients to elicit manifestations of allergic contact dermatitis. Hyperreactivity to any component molecules in Desoximetasone can manifest as allergic dermatitis. Patients should be informed to withdraw the medicine in the event of such allergic reactions.

• Local Skin Reactions: Desoximetasone can bring in various skin reactions. Some widely reported local reactions include acneiform eruptions, telangiectasias, perioral dermatitis, folliculitis, atrophy, and hypopigmentation.

• Secondary Infections: Long-term usage of Desoximetasone can result in a compromised immune response, which enhances the risk for other infections in the body. Even weaker pathogens can gain access and establish colonies in the body. Non-resolving concomitant infections that develop along with eczema may often demand cessation of Desoximetasone.

• Occlusal Dressing: Covering up the Desoximetasone applied area can accelerate medicine uptake into the blood, potentiating the side effects and making the patient susceptible to toxicity.

What Are the Drug Interactions of Desoximetasone?

Simultaneous usage of certain medicines is capable of precipitating adverse reactions. At times, such interactions may influence the efficacy of one or both medicines. Simultaneous usage of Desoximetasone's topical formulation and another topical formulation of the same class (corticosteroid) is not advisable, as it potentiates the exposure of corticosteroids in the blood. It can bring in various side effects and, at times, can result in toxicity issues.

Topical corticosteroid formulations of Triamcinolone, Prednisone, and Betamethasone are widely reported to have appreciable interactions with Desoximetasone, bringing about unwanted and adverse effects. Hence, patients should be instructed not to combine different eczema medicines. Before using any other medicines while undergoing therapy using Desoximetasone, it is better to seek expert advice from specialist doctors to ensure the safety and effectiveness of the combination.

Specific Considerations:

• Desoximetasone During Pregnancy: Desoximetasone’s topical formulations are not highly appreciable during pregnancy. It falls into the category C of pregnancy medications. Though it lacks clinical evidence for fetal toxicity in humans, non-clinical studies conducted on animal models reported teratogenic properties. It also demonstrated significant harm to the embryo upon dermal and subcutaneous exposure in the animal body in concentrations much higher than the regular human dosage.

• Desoximetasone During Lactation: No clear information is available concerning the presence of Desoximetasone in the breast milk of women undergoing topical therapy using the drug. Desoximetasone can access the baby’s body through breast milk when introduced systemically. However, there is no accurate data concerning the level of systemic exposure evoked by the local administration. Therefore, lactating women are advised not to use Desoximetasone unless under medical advice.

• Desoximetasone in the Pediatric Population: No clinical study reports are available concerning the use of Desoximetasone in the pediatric population, particularly below 18 age group. Hence, it is advised that the use of Desoximetasone be restricted in this age group as there is no clear information about the potency and safety of the medicine. In addition, children are more vulnerable to suppression of the HPA axis due to compromised body mass than the body surface area.

• Desoximetasone in the Geriatric Population: The geriatric population tolerated the topical therapy on par with the younger population without eliciting notable complications. However, caution should be exercised because of compromised functions of the kidney, heart, and liver in older patients, along with the risk of underlying medical conditions.