HOW TO CHOOSE AND USE TOPICAL CORTICOSTEROID PROPERLY?

By: dr. Geby Khomaro Putri

Supervised by: dr. Irene Dorthy Santoso, Sp.DV

Many people may have that one ‘magic’ topical cream/ointment that can make make any itch, redness or flaky skin ‘magically’ disappear. 

But, did you saw the ingredients? It probably is topical corticosteroid.  Despite its effectiveness, these cream/ointment could have mild to severe side effects if not used properly or under medical supervision.

INDICATION

Topical corticosteroid (TC) are the most frequently prescribed of all dermatologic drug products, usually to reduce inflammation. Few indications to use TC are rash and itching lesions, dermatitis, eczema, psoriasis etc.

POTENCY

TC has different potency and function based on :

  1. Main ingredient
    • Mild
      • Betamethasone valerate lotion (0.05%)
      • Desonide cream (0.05%)
      • Fluocinolone acetonide solution (0.01%)
      • Hydrocortisone acetate cream (1%)
    • Moderate
      • Desoximetasone cream (0.05%)
      • Triamcinolone acetonide cream (0.1%)
      • Betamethasone valerate cream (0.1%)
      • Fluocinonide acetonide cream (0.025%)
      • Triamcinolone acetonide lotion (0.1%)
    • Potent
    • Super potent
  2. Formulation
    • There are many formulation available in the market, but these 3 are the most common and used formulation:
    • Ointment
      • Most occlusive and potent
      • For dry, non-hairy skin and thick lesion
      • May cause : miliaria, folliculitis, maceration
    • Cream
      • Less potent than ointment
      • For skin with hair
      • May cause : Irritation, stinging or allergic reaction (due to preservative)
    • Gel, lotion and foam
      • Least occlusive and greasy
      • For skin with hair and scalp
      • May cause:drying effect (due to alcohol)
  3. Absorption
    • Thin, moist and occlussive  area (ex. eyelid, groin, genitalia, folds of the arm, etc) will absorb more product

HOW TO USE

Mild potency (OTC product)

Choose the correct formulation based on your need

Spread TC in a thin layer only on the lesion

Use once to twice daily (only on affected skin area) for up to 2 weeks

If emmolient is used, apply it first, wait 30 minutes then apply TC

Moderate to Super Potent (Prescribed product)

Use according to doctor’s prescription, because side effects potential are greater than OTC product

REMEMBER ! You should know the potency of steroid before use it

SIDE EFFECTS

  1. Local
    • Temporary stinging or burning at lesion site (most common)
    • Hypertrichosis
    • Stretch mark
    • Skin thinning & atrophy
    • Telangiectasis
    • Perioral dermatitis
    • Steroid-induced acne/rosacea
    • Etc
  2. Systemic
    • Cushing syndrome
    • Hypertension
    • Decreased growth rate
    • Etc

IMPORTANT NOTES!

DO NOT use any topical steroid if :

  • you have infected skin
  • you have acne/rosacea, or open sore

DO NOT use potent and ointment steroid on thin and moist area because it has greater risk to induce side effects

References:
1.https://emedicine.medscape.com/article/2172256-overview
2.https://www.medicinenet.com/corticosteroids-topical/article.htm#what_are_examples_of_topical_corticosteroids_available_in_the_us
3. https://www.nhs.uk/conditions/topical-steroids/
4. https://dermnetnz.org/topics/topical-steroid/
5. https://www.aafp.org/afp/2009/0115/p135.html
6.https://www.idoj.in/article.asp?issn=2229-5178;year=2014;volume=5;issue=4;spage=416;epage=425;aulast=Coondoo

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