CORTICOSTEROIDS

Topical Glucocorticoids

- Most frequently prescribed of all dermatologic drug products

- Effective at reducing the symptoms of inflammation but do not address the underlying cause of
the disease
- Vasoconstrictive effects on dermal capillaries
- Antiproliferative effect
- Reduce the keratinocyte size and proliferation
- Inhibits fibroblast activity and collagen formation
- Cause capillaries in superficial dermis to constrict thus decreasing erythema

Potency Ranking

Class I Superpotent
Clobetasol propionate 0.05%
Fluocinonide 0.1%
Halobetasol propionate 0.5%
Betamethasone depropionate 0.5%

Class II Potent
Desoximetasone 0.05%
Fluocinonide 0.05%
Halobetasol propionate 0.05%
Mometasone furoate 0.1%

Class III Potent, Upper mid strength

Betamethasone valerate 0.1%
Betamethasone deproprionate 0.05%
Fluticasone propionate 0.005%
Triamcinolone acetonide 0.5%

Class IV Midstrength
Betamethasone valerate 0.1%
Decamethasone 0.05%
Fluocinolone acetonide 0.025%
Hydrocortisone valerate 0.2%
Mometasone furoate 0.1%
Triamcinolone acetonide 0.1%

Class V Lower midstrength

Betamethasone valerate 0.05%
Betamethasone diproprionate 0.05%
Fluocinolone acetonide 0.01%
Hydrocortisone butyrate 0.1%
 Hydrocortisone valerate 0.2%

Class VII Least Potent

Topicals with Hydrocortisone
Prednisolone
Flumethasone
Methylprednisolone

Responsiveness of Dermatoses to Topical application of Corticosteroids

Highly Responsive
- Atopic Dermatitis
- Intertrigo
- Seborrheic dermatitis
- Psoriasis (intertriginous)

Moderately Responsive

- Atopic Dermatitis in adults

- Lichen simplex chronicus
- Nummular eczema
- Parapsoriasis
- Psoriasis
- Primary irritant dermatitis

Least Responsive

- Dyshidrotic eczema
- Insect bites
- Granuloma annulare
- Lichen planus
- Lupus erythematosus
- Palmoplantar psoriasis
- Pemphigus
- Psoriasis of nails
- Sarcoidosis
- Acute phase of allergic contact dermatitis

Principles when initiating topical steroids therapy

- Initiate lowest potency to sufficiently control the disease

- Topical corticosteroid without anti-bacterial contents should be avoided on atrophic or
ulcerated skin or with coexistent infectious dermatoses
- Prolonged use should be avoided
 - Treatment with low-medium potency corticosteroid is recommended for large surface areas
- Highly responsive dermatoses will usually respond to weak steroids
- Less responsive diseases usually require medium to high potency preparations
- Low potency steroids should be used in the face and intertriginous areas
- Very potent steroid preparations frequently under occlusion, is usually required for
hyperkeratotic or lichenified dermatoses and those with involvement of palms and soles
- In infants and young children, high-potency steroids are avoided due to increased body surface
areas and to body mass index ratio and also due to an increased risk of systemic abruption

Adverse effects

1. Skin atrophy
o More likely to occur with high potency topical corticosteroids
2. Acneiform eruption
o Steroids initially lead to suppression of inflammation but flares happen when treatment
is withdrawn
o Discourage in treatment of rosacea and periocular dermatitis
3. Risk if infections
o Topical corticosteroids may exacerbate cutaneous infections

Continuing use of Topical Steroids

1. Use highly potent preparation for shortened periods (2-4 wks) or intermittently
2. Sudden discontinuation is avoided after prolonged topical steroid use to prevent rebound
phenomenon
3. Use combination therapy when clinically indicated
4. When disease control is partially achieved, do alternate day therapy or decrease dosage to once
a day

SYSTEMIC GLUCOCORTICOIDS

- Potent immunosuppressive and anti-inflammatory preparations frequently used for severe

dermatoloc disorders
- Either intralesional, IV, or IM routes
- Careful monitoring of side effects is needed
- Complications are increased:
o Increased doses
o Using fluorinated compounds
o Long duration
o More frequent administration
- Most common indications of systemic steroids
o Serious Blistering diseases:
 Pemphigus
  Bullous pemphigoid
 Erythema multiforme
 Toxic epidermal necrolysis
 Epidermolysis bullosa acquisita
o Vasculitis
o Sarcoidosis
o Urticaria angioedema
o Connective tissue diseases
 Dermatomyositis
 Systemic Lupus Erythematosus
 Eosinophilic fasciitis
o Type I reactive leprosy
o Hemangioma of Infancy
o Panniculitis

Side effects:

1. Diet
o Encourage protein intake to reduce steroid-induced nitrogen wasting
o Encourage exercise
o Limit coffee, alcohol intake
o Should be low in calories, fat and sodium
o Should be high in protein, potassium and calcium
2. Increased risk for infections
3. Adrenal suppression
4. Osteoporosis
5. Cardio