Monday 27 November, 2006

Topical corticosteroids

Posted in Dermatology, General Practice, May Su, Wards at 22:18 by May Su

Original article by: May Su :: Printer friendly

Topical corticosteroids are used for a variety of dermatological conditions – dermatitis (atopic eczema), psoriasis, or in conjunction with anti-fungal agents for severe tinea.

There is a confusing array of topical steroid preparations available in Australia. The question is which to use, and when.

Potency is dependent on the type of corticosteroid, the vehicle it is applied with (i.e., lotion, cream or ointment) and whether an occlusive dressing is used.

Potency is directly proportional to the risk of side effects associated with their use. It is preferable to use the lowest potency agent required to effect treatment.

Main side effects are:

  • loss of dermal collagen (skin atrophy, striae, fragility and easy bruising)
  • telangiectasia
  • and perioral dermatitis.
  • In very large amounts of use, there is a theoretical risk of systemic effects such as suppression of the hypothalamic-pituitary axis.

In general we use lower potency topical corticosteroids in more sensitive areas like the face or scotum, as there tends to be better absoption in these areas.

Potency

Type of corticosteroid:

Below is a list of potencies of topical corticosteroids (adapted from the Therapeutic Guidelines – Dermatology) (1):

Corticosteroid Conc. Trade names (Australia)
Class 1 (mild)
desonide 0.05% Desowen (lotion)
hydrocortisone 0.5, 1% Dermaid cream, Dermain Soft Cream, Egocort cream 1%
hydrocortisone acetate 0.5, 1% Cortaid (cream), Cortef (cream), Cortic-DS (cream and ointment), Sigmacort (cream and ointment)
Class 2 (moderate)
betamethasone valerate 0.02%, 0.05% Antroquoril (cream and ointment), Betnovate 1/2 (cream and ointment), Betnovate 1/5 (cream), Celestone M (cream and ointment), Cortival 1/2 (cream and ointment), Cortival 1/5 (cream)
triamcinolone acetonide 0.02% Aristocort (cream and ointment), Tricortone (cream and ointment)
Class 3 (potent)
betamethasone dipropionate 0.05% Diprosone Dermatologicals (lotion, cream and ointment), Eleuphrat (lotion, cream and ointment)
betamethasone valerate 0.1% Betnovate (cream and ointment)
methylprednisolone aceponate 0.1% Advantan (lotion, cream, ointment, fatty ointment)
mometasone furoate 0.1% Elocon (lotion, cream and ointment), Novasone (lotion, cream and ointment)
triamcinolone acetonide 0.1% N/A
Class 4 (very potent)
betamethasone diproprionate 0.05% in optimised vehicle Diprosone OV (cream and ointment)

Vehicle

In ascending order of potency:

  • lotion
  • cream
  • ointment
  • fatty ointment (methylprednisone aponate, or Advantan only)

Occlusion

The topical corticosteroid is made more potent by the application of an occlusive dressing.

Other therapeutic managment

Other things to bear in mind for dermatitis/ dry skin:

  • Avoid soaps and perfumes. Use a soap substitute such as QV wash.
  • Short showers, preferable less than 3 minutes and avoid overly hot water.
  • Apply a hypoallergenic moisturiser all over after a shower, e.g., Sorbolene with 10% glycerine.
  • Reapply moisturiser frequently.
  • Cotton clothing. Avoid wool and synthetic fabrics against skin.

References

(1) Classification of potencies of topical corticosteroids (Table 4.9). Therapeutic Guidelines: Dermatology (2004).

Please read the disclaimer

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11 Comments »

  1. Michael Tam said,

    As far as I’m concerned, topical corticosteroids are irritatingly confusing due to the number that are available on the market. In the end, you will probably end up using just a few brands that you know well.

    For the sake of convenience, I prefer prescribing patients topical corticosteroids that come in large quantities.

    In general, start with the mild topical corticosteroids first and move up in strength as needed. Creams (moist, easily dissolves into skin) are usually better tolerated than ointment (thick and greasy) but ointments do tend to work better.

  2. Ewen McPhee (Rural GP) said,

    This looks like a great site guys. Can I just comment on a couple of things. First of all I tend to use ointments more because they are occlusive and have better penetration and better clinical benefit (they also have no preservatives to cause an allergy), and reserve creams for the Flexures and face. I aggree that you should just pick one mild, mid and high potency CST and stick to them.
    The other thing is to give enough treatment to cover the disease for as long as required. I use the finger tip unit to gauge how much cream u need (0.5gm = the distance a dispensed cream goes from the distal IP joint to the finger tip, and the space covered by 4 closed hands = 2 FTU = 1gm). I phone for an authority after working out how many grams are needed each day to properly cover the skin.

  3. Michael Tam said,

    Thanks for the practice tips!

    Cheers.

  4. tovorinok said,

    Hello

    Great book. I just want to say what a fantastic thing you are doing! Good luck!

    G’night

  5. I am looking to buy very small 5grams tubes of betnovate cream.Its bought in south asian countries to mix with other creams to wear in hot weathers.

    We cannot get it in the uk.its called betnovate cream.please could you help to locate where i could buy this from thankyou

    maysarah

  6. Michael Tam said,

    I do not live or work in the United Kingdom so naturally, I have absolutely no idea where you can buy 5 g tubes of Betnovate cream.

  7. Harry Gunz said,

    How do you feel about the use of Novasone Lotion 0.1% used daily by a female under the fingernails? My wife has a fungal infection (rather like “barmaids rot”) under her nails and has been prescribed the above lotion to use for about six months.
    Nothing previously prescribed has been successful and I am a little concerned about corticosteroids being prescribed (by a skin specialist) for such a long period.
    If you are in favour of its use, what important precautions should be adhered to and what must she avoid doing or what should she do?

  8. Michael Tam said,

    It would be best to follow up any concerns with your treating physician. It is impossible for me to comment given I have neither taken a history or examined your wife.

  9. Michelle said,

    Could you tell me if diprosone and eleuphrat are the same? I asked my GP for a prescription for diprosone and was given eleuphrat (by mistake?) are they used for the same condition?
    Thanks

    • Fiona Hutchison said,

      Diprosone and eleuphrat are the same.

  10. Cecille said,

    is there any reason why cortisone often the preferred treatment to elidel cream? or how do we know if elidel would work better on an eczema sufferer compared to cortisone?


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