topical glucocorticoid (topical steroid)
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Introduction
Agents applied to skin. Excludes nasal & inhaled glucocorticoids
Classification
- class 1 (most potent)*
- clobetasol propionate 0.05%
- betamethasone dipropionate ointment 0.05% (Diprolene)
- halobetasol propionate 0.05% (Ultravate)
- diflorasone diacetate 0,05% (Psorcon)
- class 2
- augmented betamethasone diproprionate cream 0.05% (Diprosone) (in optimized vehicle)
- fluocinonide 0.05%
- desoximetasone 0.25%
- class 3 (high potency)
- betamethasone dipropionate cream 0.05%
- betamethasone valerate ointment 0.1%
- triamcinolone acetonide ointment 0.1%
- triamcinolone acetonide cream 0.5%
- fluticasone propionate ointment 0.05%
- class 4
- triamcinolone acetonide cream 0.1%
- hydrocortisone valerate ointment 0.2%
- fluocinolone acetonide ointment 0.025%
- fluticasone propionate cream 0.05%
- class 5
- betamethasone valerate cream 0.1%
- hydrocortisone valerate cream 0.2%
- triamcinolone acetonide lotion 0.1%
- fluocinolone acetonide cream 0.025%
- class 6
- betamethasone valerate lotion 0.05%
- desonide cream 0.05%
- fluocinolone acetonide cream 0.01%
- fluocinolone acetonide solution 0.05%
- class 7 (least potent)*
- hydrocortisone 1-2.5%
* classification from most to least potent
Contraindications
- pregnancy category C but generally appear safe[4]
- avoid use of potent topical glucocorticoids on the face, neck, intertriginous skin folds, groin & on atrophic skin[2]
- avoid combined use of glucocorticoids with antifungal agents[2]
Adverse effects
- common*
- skin atrophy, thinning & wrinkling of skin
- more likely to occur in intertriginous areas, the face, & popliteal fossa or antecubital fossa
- striae, visible veins, telangiectasia
- acne, rosacea
- perioral dermatitis
- easy bruising, purpura
- skin atrophy, thinning & wrinkling of skin
- less common
- hypertrichosis
- pigmentation alterations
- delayed wound healing
- exacerbation of skin infections
- other
- contact sensitization
- systemic reactions with chronic use of potent agents[2][6]
- hyperglycemia
- systemic absorption may increase risk of type 2 diabetes[12]
- glaucoma
- cataracts[7][8]
- adrenal insufficiency
- high doses of potent glucocorticoid during pregnancy may result in low birth weight infant[4]
- potent topical glucocorticoids associated with increased risk for osteoporosis & major fracture (< 122/10,000 patient years)[14]
- hyperglycemia
* adverse effects more common when applied to areas of occlusion by clothing or skin folds[2]; use least potent topical glucocorticoid when appled to these areas[7]
- drug adverse effects of glucocorticoids
- drug adverse effects of topical glucocorticoids
- drug adverse effects of immunosuppressive agents
Drug interactions
- avoid use of antifungal agents with topical glucocorticoids
- drug interaction(s) of methotrexate with biological response modifier
- drug interaction(s) of glucocorticoids with warfarin
- drug interaction(s) of NSAIDs with glucocorticoid
Mechanism of action
- anti-inflammatory
- inhibits collagen production
Notes
- co-pay & wholesale price vary widely for topical glucocorticoids[9]
- Medicare part D costs for topical glucocorticoids increased substantially from 2011-2015[11]
- there is a generic equivalent in each class of topical glucocorticoid[2]
More general terms
More specific terms
- Alclometasone Topical (Aclovate, Acloson, Delonal)
- Amcinonide Topical
- antibiotic-glucocorticoid combination
- Betamethasone Topical (Betatrex, Diprolene, Diprosone, Luxig foam, Valisone)
- clocortolone topical (Cloderm)
- Cortisol Topical (Westcort, Locoid, Hytone, Lacticare HC, Pramosome)
- Desonide Topical (DesOwen, Tridesilon)
- Desoximetasone Topical
- Diflorasone Topical (Psorcon, Florone, Maxiflor)
- difluprednate (Durezol)
- Fluocinolone Topical (Synalar, Synemol, Fluonid, Derma-Smoothe/FS, Synandrone)
- Fluocinonide Topical (Lidex)
- Flurandrenolide Topical (Cordran)
- Fluticasone Topical (Cutivate)
- Halcinonide Topical (Halog)
- halobetasol topical (Ultravate)
- Mometasone Topical
- prednicarbate topical (Dermatop E)
- Triamcinolone Topical (Aristocort, Kenacort)
References
- ↑ Prescriber's Letter 16(12): 2009 Comparison of Topical Corticosteroids Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=251227&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2022.
- ↑ Prescriber's Letter 18(10): 2011 Hyperglycemia Associated with Non-oral and Locally Injected Corticosteroids Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=271022&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 4.0 4.1 4.2 Chi CC et al Pregnancy Outcomes After Maternal Exposure to Topical Corticosteroids. A UK Population-Based Cohort Study. JAMA Dermatol. Published online September 04, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24005903 <Internet> http://archderm.jamanetwork.com/article.aspx?articleid=1735120
- ↑ Del Rosso J, Friedlander SF. Corticosteroids: options in the era of steroid-sparing therapy. J Am Acad Dermatol. 2005 Jul;53(1 Suppl 1):S50-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15968264
- ↑ 6.0 6.1 Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006 Jan;54(1):1-15 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16384751
- ↑ 7.0 7.1 7.2 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - ↑ 8.0 8.1 Haeck IM, Rouwen TJ, Timmer-de Mik L Topical corticosteroids in atopic dermatitis and the risk of glaucoma and cataracts. J Am Acad Dermatol. 2011 Feb;64(2):275-81 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21122943
- ↑ 9.0 9.1 Skojec A, Foulke G, Kirby JS. Variation in the Cost of Generic Topical Corticosteroids. JAMA Dermatol. 2015 Aug 19 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26288382
- ↑ Beer K, Downie J. Sequelae from inadvertent long-term use of potent topical steroids. J Drugs Dermatol. 2007 May;6(5):550-1 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17679193
- ↑ 11.0 11.1 Song H, Adamson A, Mostaghimi A. Medicare Part D payments for topical steroids: Rising costs and potential savings. JAMA Dermatol 2017 Aug; 153:755. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28453645 <Internet> http://jamanetwork.com/journals/jamadermatology/article-abstract/2623534
- ↑ 12.0 12.1 Andersen YMF, Egeberg A, Ban L et al. Association between topical corticosteroid use and type 2 diabetes in two European population-based adult cohorts. Diabetes Care 2019 Jun; 42:1095 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30936111 <Internet> http://care.diabetesjournals.org/content/42/6/1095
- ↑ Ference JD, Last AR Choosing topical corticosteroids. Am Fam Physician. 2009 Jan 15;79(2):135-40. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19178066 Free article.
- ↑ 14.0 14.1 Egeberg A, Schwarz P, Harslof T et al Association of Potent and Very Potent Topical Corticosteroids and the Risk of Osteoporosis and Major Osteoporotic Fractures. JAMA Dermatol. Published online January 20, 2021. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33471030 https://jamanetwork.com/journals/jamadermatology/article-abstract/2775153
Jackson RD Topical Corticosteroids and Glucocorticoid-Induced Osteoporosis - Cumulative Dose and Duration Matter. JAMA Dermatol. Published online January 20, 2021 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33471024 https://jamanetwork.com/journals/jamadermatology/article-abstract/2775150