Topical steroid
Topical steroids are the topical forms of corticosteroids. Topical steroids are the most commonly prescribed topical medications for the treatment of rash and eczema. Topical steroids have anti-inflammatory properties and are classified based on their skin vasoconstrictive abilities. There are numerous topical steroid products. All the preparations in each class have the same anti-inflammatory properties but essentially differ in base and price.
Side effects may occur from sudden discontinuation and prolonged, continuous use can lead to skin thinning. Intermittent use of topical steroids for atopic dermatitis is safe and does not cause skin thinning.
Medical uses
Weaker topical steroids are utilized for thin-skinned and sensitive areas, especially areas under occlusion, such as the armpit, groin, buttock crease, and 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, xerotic eczema, lichen sclerosis et atrophicus of the vulva, scabies and severe dermatitis. Strong steroids are used for psoriasis, lichen planus, discoid lupus, chapped feet, lichen simplex chronicus, severe poison ivy exposure, alopecia areata, nummular eczema, and severe atopic dermatitis in adults.For treating atopic dermatitis, newer corticosteroids, such as fluticasone propionate and mometasone furoate, are more effective and safer than older ones. They are also generally safe and do not cause skin thinning when used intermittently to treat atopic dermatitis flare-ups. They are also safe when used twice a week for preventing flares. Applying once daily is enough as it is as effective as twice or more daily application.
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. Long-term use of topical steroids can lead to secondary infection with fungus or bacteria, skin atrophy, telangiectasia, skin bruising and fragility.
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.
Adverse effects
- Hypothalamic–pituitary–adrenal axis suppression
- Cushing's syndrome
- Diabetes mellitus
- Osteoporosis
- Topical steroid addiction
- Allergic contact dermatitis
- Steroid atrophy
- 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 intraocular pressure and increase the risk of glaucoma, cataract, retinopathy as well as systemic adverse effects.
- Tachyphylaxis: The acute development of tolerance to the action of a drug after repeated doses. Significant tachyphylaxis can occur by day 4 of therapy. Recovery usually occurs 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.
- Delivery-related adverse effects
- Other local adverse effects: These include facial hypertrichosis, folliculitis, miliaria, genital ulcers, and granuloma gluteale infantum. Long-term use has resulted in Norwegian scabies, Kaposi's sarcoma, and other unusual dermatosis.
Safety in pregnancy
Classification systems
Seven-class System
The U.S. utilizes 7 classes, which are classified by their ability to constrict capillaries and cause skin blanching. Class I is the strongest, or superpotent. Class VII is the weakest and mildest.Class I
Very potent: up to 600 times stronger than hydrocortisone- Clobetasol propionate 0.05%
- Betamethasone dipropionate 0.25%
- Halobetasol propionate 0.05%
- Diflorasone diacetate 0.05%
Class II
- Fluocinonide 0.05%
- Halcinonide 0.05%
- Amcinonide 0.05%
- Desoximetasone 0.25%
Class III
- Triamcinolone acetonide 0.5%
- Mometasone furoate 0.1%
- Fluticasone propionate 0.005%
- Betamethasone dipropionate 0.05%
- Halometasone 0.05%
Class IV
- Fluocinolone acetonide 0.01–0.2%
- Hydrocortisone valerate 0.2%
- Hydrocortisone butyrate 0.1%
- Flurandrenolide 0.05%
- Triamcinolone acetonide 0.1%
- Mometasone furoate 0.1%
Class V
- Fluticasone propionate 0.05%
- Desonide 0.05%
- Fluocinolone acetonide 0.025%
- Hydrocortisone valerate 0.2%
Class VI
- Alclometasone dipropionate 0.05%
- Triamcinolone acetonide 0.025%
- Fluocinolone acetonide 0.01%
- Desonide 0.05%
Class VII
- Hydrocortisone 2.5%
- Hydrocortisone 1%
Five-class System
Four-class System
Many countries, such as the United Kingdom, Germany, the Netherlands, New Zealand, recognize 4 classes. In the United Kingdom and New Zealand I is the strongest, while in Continental Europe, class IV is regarded as the strongest.Class IV (UK/NZ: class I)
Very potent- Clobetasol propionate
- Betamethasone dipropionate
Class III (UK/NZ: class II)
- Betamethasone valerate
- Betamethasone dipropionate
- Diflucortolone valerate
- Hydrocortisone 17-butyrate
- Mometasone furoate
- Methylprednisolone aceponate
- Halometasone 0.05%
Class II (UK/NZ: class III)
- Clobetasone butyrate
- Triamcinolone acetonide
Class I (UK/NZ: class IV)
- Hydrocortisone 0.5–2.5%
Allergy associations