Topical steroids are the topical forms of corticosteroids. Topical steroids are the most commonly prescribed topical medications for the treatment of rashes, eczema, and dermatitis. Topical steroids have anti-inflammatory properties, and are classified according to their skin's vasoconstriction ability. There are many topical steroid products. All the preparations in each class have the same anti-inflammatory properties, but are essentially different in basis and price.
Over the past decade, much awareness has been brought to the side effects and damage to long-term topical steroid use, especially in cases where it is used for the treatment of eczema.
Video Topical steroid
Medical use
The weaker topical steroids are used for thin-skinned and sensitive areas, especially areas under occlusion, such as the armpit, groin, buttocks, breast folds. Weaker steroids are used on the face, eyelids, diaper area, perianal skin, and intertrigo groin or body folds. Steroids are being used for atopic dermatitis, nummular eczema, xerotic eczema, lichen sclerosis et atrophicus on the vulva, scabies (after scabiecide) and severe dermatitis. Strong steroids are used for psoriasis, lichen planus, discoid lupus, cracked feet, lichen simplex chronicus, severe ivy poison exposure, alopecia areata, nummular eczema, and severe atopic dermatitis in adults.
To prevent tachyphylaxis, topical steroids are often prescribed for use on a week, week off routine. Some recommend using topical steroids for 3 consecutive days, followed by 4 consecutive days. Use of long-term topical steroids may cause secondary infections with fungi or bacteria (see tinea incognito), skin atrophy, telangiectasia (prominent veins), bruised skin and brittleness.
Use of fingertip units can help in guiding how many topical steroids are needed to cover different areas of the body.
Maps Topical steroid
Adverse effects
- The hypothalamus hypothalamus hypothalama hypothesis (HPA) hypothalamus
- Cushing's Syndrome
- Diabetes mellitus
- Osteoporosis
- Topical steroid addiction
- Allergic contact dermatitis (see steroid allergy)
- Steroid atrophy
- Perioral dermatitis: This is a rash that occurs around the mouth and eye area that has been associated with a topical steroid.
- Ocular effects: Topical steroidal drops are often used after eye surgery but may also increase intra-ocular pressure (IOP) and increase the risk of glaucoma, cataracts, retinopathy and systemic side effects.
- Tachyphylaxis: Acute development of tolerance to drug action after repeated doses. Significant tachyphylaxis can occur on day 4 of therapy. Recovery usually occurs after 3 to 4 days of rest. This has led to therapies such as 3 days, 4 days off; or one week of therapy, and one week off therapy.
- Adverse effects related to delivery
- Other local adverse effects: These include facial hypertrichosis, folliculitis, miliaria, genital ulcers, and infective gluteale granuloma. Long-term use has resulted in Norwegian mange, Kaposi sarcoma, and other unusual dermatoses.
System classification
USA System
The USA system uses 7 classes, which are classified by their ability to narrow capillaries and cause skin blanching. Class I is the strongest, or the superpotent. Class VII is the weakest and lightest.
Class I
Very strong: up to 600 times stronger than hydrocortisone
- Clobetasol propionate 0.05% (Dermovate)
- Betamethasone dipropionate 0.25% (Diprolene)
- Halobetasol propionate 0.05% (Ultravate, Halox)
- Diflorasone diacetate 0.05% (Psorcon)
Class II
- 0.05% Fluocinonide (Lidex)
- Halcinonide 0.05% (Halog)
- Amcinonide 0.05% (Cyclocort)
- Desoximetasone 0.25% (Topicort)
Class III
- Triamcinolone acetonide 0.5% (Kenalog, Aristocort cream)
- Mometasone furoate 0.1% (Elocon, Elocom ointment)
- Fluticasone propionate 0.005% (Cutivate)
- Betamethasone dipropionate 0.05% (Diprosone)
- Halomethasone 0.05%
Class IV
- Fluocinolone acetonide 0.01-0.2% (Synalar, Synemol, Fluid)
- Hydrocortisone valerate 0.2% (Westcort)
- Hydrocortisone smoothed 0.1% (Locoid)
- 0.05% Flurandrenolide (Cordran)
- Triamcinolone acetonide 0.1% (Kenalog, Aristocort A ointment)
- Mometasone furoate 0.1% (Elocon cream, lotion)
Class V
- Fluticasone propionate 0.05% (Cutivate cream)
- Desonide 0.05% (Tridesilon, DesOwen ointment)
- Fluocinolone acetonide 0,025% (Synalar Cream, Synemol)
- Hydrocortisone valerate 0.2% (Westcort cream)
Class VI
- Alclometasone dipropionate 0.05% (Aclovate cream, ointment)
- Triamcinolone acetonide 0,025% (Aristocort A cream, Kenalog lotion)
- 0.01% acetonid fluluinolone (Capex shampoo, Dermasmooth)
- Desonide 0.05% (cream, lotion DesOwen)
Class VII
The weakest topical steroid class. Has poor lipid permeability, and can not penetrate the mucous membranes properly.
- 2.5% hydrocortisone (Hytone cream, lotion, ointment)
- Hydrocortisone 1% (Many brands are sold free)
Other countries
Most other countries, such as Britain, Germany, the Netherlands, New Zealand, only recognize 4 classes. In England and New Zealand, I am the strongest, while in the Continent of Europe, the fourth class is considered the strongest.
Class IV
Very powerful (up to 600 times stronger than hydrocortisone)
- Clobetasol propionate (Dermovate Cream/Ointment, Exel Cream)
- Betamethasone dipropionate (Diprosone OV Cream/Ointment, Diprovate Cream)
Class III
Powerful (50-100 times as strong as hydrocortisone)
- Betamethasone valerate (Beta Cream/Salep/Scalp Application, Betnovate Lotion/C Cream/C Ointment, Fucicort)
- Betamethasone dipropionate (Diprosone Cream/Ointment, Diprovate Cream, Daivobet 50/500 Ointment)
- Diflucortolone valerate (Nerisone C/Cream/Fatty Ointment/Ointment)
- Hydrocortisone 17-butyrat (Locoid C/Cream/Crelo Topical Emulsion/Lipocream/Scalp/Scalp Lotion)
- Mometasone furoate (Elocon Cream/Lotion/Ointment)
- Methylprednisolone aceponate (Advantan Cream/Salep)
- Halomethasone 0.05%
Class II
Medium (2-25 times stronger than hydrocortisone)
- Butirat Clobetasone (Eumovate Cream)
- Triamcinolone acetonide (Aristokort Creams/Creams, Creative Cream/Viaderm KC, Kenacomb Ointment)
Class I
Light
- Hydrocortisone 0.5-2.5% (DermAid Cream/Soft Cream, 1% -HC HC Lotion, Skincalm, HC Lemon Fatty Cream, Pimafucort Cream/Salep)
Japanese Classification
Japan rated topical steroids from 1 to 5, with 1 strongest.
Allergic association
Steroids highlighted are often used in allergy screening of topical steroids and systemic steroids. When a person is allergic to one group, a person is allergic to all steroids in that group.
Group A
Hydrocortisone, hydrocortisone acetate, cortisone acetate, tixocortol pivalate, prednisolone, methylprednisolone, and prednisone
Group B
Triamcinolone acetonide, triamcinolone alcohol, amcinonide, budesonide, desonide, fluocinonide, fluocinolone acetonide, and halcinonide
Group C
Betamethasone, betamethasone sodium phosphate, dexamethasone, dexamethasone sodium phosphate, and fluocortolone
Group D
Hydrocortisone-17-butyrate, hydrocortisone-17-valerate, alclometasone dipropionate, betamethasone valerate, betamethasone dipropionate, prednicarbate, clobetasone-17-butyrate, Clobetasol-17 propionate, fluocortolone caproate, fluocortolone pivalate, fluprednidene acetate, and mometasone furoate
History
Corticosteroids were first available for general use around 1950.
See also
- Topic
- Glucocorticoids
- Corticosteroids
- Retrometabolic drug design
References
Source of the article : Wikipedia
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