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Rational Use of Topical Steroids

Published on Jul 29, 2019   -  3 min read

Abstract

A significant proportion of dermatological conditions are treated by physicians other than a dermatologist. This article aims to provide information regarding the rational and safe use of topical steroids to improve the effectiveness and prevent adverse effect; thereby decrease unnecessary medical expenses.

Rational Use of Topical Steroids

A significant proportion of dermatological conditions are treated by physicians other than a dermatologist, and all of them prescribe topical corticosteroids for most of these conditions. But the clinical outcome will depend not only on making a correct diagnosis, but also prescribing the right molecule in the most appropriate vehicle for the exact duration.

The classification of topical corticosteroids was based on how much vasoconstriction they cause and on some comparative clinical trials. There are seven classes of corticosteroid ranging from most potent (class1) to least potent (class 7). Topical preparations which have similar active compound but differ in their concentration or vehicle have variable potency and efficacy. Let us consider the factors affecting the effectiveness of topical corticosteroid treatment.

Indications:

Establishing a clinical diagnosis is the most important thing before prescribing a topical steroid.

Drug Formulation:

The potency of steroid may vary depending on the vehicle in which it is formulated.

Location:

Dermatoses of the face and intertriginous areas are best treated with a low potent preparation. While lesions on palm and soles frequently require high potent steroids.

Method of Application:

Because hydration generally promotes steroid penetration, applying topical steroid after a shower or wetting the area improves effectiveness. Occlusion increase penetration. A simple plastic dressing increases the penetration by several-fold, as compared to dry skin. Occlusive dressing should not be applied to the face or intertriginous area. Folliculitis and irritation are common side effects of occlusion, so patients should be counseled and closely monitored.

Frequency and Dosage:

Once or twice daily application is recommended for most preparation. Treatment should not be longer than two weeks on the face and 3 to 4 weeks on the rest of the body. The longterm application can cause tolerance and tachyphylaxis. And also side effects like atrophy, telangiectasia, etc. Ultra potent steroid should not be used more than three weeks continuously. If needed for a more extended period, taper gradually and use intermittently.

The amount of steroid to apply is measured by Finger Tip Units (FTU). One hand size of skin requires 0.5 FTU or 0.25 mg steroid.

To conclude, topical steroids are safe and effective. Always establish a clinical diagnosis before prescribing and choose an appropriate topical steroid according to the affected area, clinical presentation, and predicted response to treatment. Monitor for clinical response and adverse effects. Consider stopping or changing the drug depending on response. Refer to a dermatologist if the disease does not respond to your treatment or when the diagnosis is unclear.

 

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Last reviewed at:
29 Jul 2019  -  3 min read

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