Steroids for dermatitis
Steroids for dermatitis
Topical steroids are usually grouped into the following potency categories:
Class 1: hydrocortisone 1%
Class 2: clobetasone 0.05%; flumetasone 0.02%; hydrocortisone butyrate 0.1%; triamcinolone acetonide 0.1%
Class 3: betamethasone dipropionate 0.05%; betamethasone valerate 0.1%; desoximetasone 0.25%; diflucortolone 0.1%; fluticasone 0.05%; mometasone furoate 0.1%
Class 4: betamethasone dipropionate 0.05% in propylene glycol; clobetasol 0.05%
Click here for an overview of all corticosteroids and classes
Based on these classes, the systemic effects due to suppression of the HPA axis can be predicted:
Class 1 - Virtually never
Class 2 - Unlikely except in babies
Class 3 & 4 - If used on extensive areas in large quantities over a long period especially in patients under 5 years of age.
Local effects such as thinning of the skin, striae, and telangiectasia are more likely to occur with the higher classes. To avoid both the systemic and local effects it is best to follow the following rules:
1. Start with the lowest potency as possible.
2. Avoid all except low and occasionally low medium to face.
3. Prescribe the corticoid cream for a short period of time. (Use high and very high only for one week at a time.)
4. Tachyphylaxis (saturation of the corticoid receptors): apply the corticosteroid for max. 5 days and treat with an indifferent cream for 2-4 days. Otherwise the steroid can be changed within the same potency group every week.
5. Polythene occlusion: helpful in adults but rarely used in children.
For further information see: steroids for dermatitis
HPA suppression from long-term use of topical hydrocortisone in a 34 year old male with psorasis on his elbows is:
Extra info: Despite the long-term use, the risk is low since hydrocortisone is a class 1 agent, it is being used by a 34 year old man, and being applied to a limited area.
The site of action for topical steroids is in the:
Extra info: Because corticosteroids mechanism of action is involves binding of a nuclear receptor, topical steroids will work in any location in which there are functioning nucleated cells.
The use of bandages (occlusion) in the treatment of atopic dermatitis helps to:
What is not true in the management of dermatitis?
Extra info: Ketoconazole is an anti-fungal agent, which would be used in skin infections, not atopic dermatitis.