Transcript Topical steroids (2008) Dr. Amal Kokandi MB,BCh, MSc, MD

Topical steroids (2008)
Dr. Amal Kokandi
MB,BCh, MSc, MD
Mode of action
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Anti-inflamatory
Immunosuppression
Vasoconstriction
Antimtotic
Glucocorticoid activity
• Cushing’s syndrome
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Mineralocorticoid activity
Antimetabolic effect
• striae, dermal atrophy, and ecchymosis)
Uses
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Common indications for topical
steroids:
• Eczema
• Pityriasis rosea
• Lichen planus
• Alopecia areata
• Psoriasis (some forms)
• vitiligo
Special considerations
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Face
Intertriginous areas
Children
Effect of occlusion
infections and combination formulas
(with antibiotics and antifungals)
Finger tip unit
Finger tip unit
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2 FTU = nearly 1 gram
Enough for twice size of adult hand
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A hand and fingers (front and back) = 1FTU
A foot (all over) + 2FTU
Front of chest and abdomen = 7FTU
Back and buttocks = 7FTU
Face and neck = 2.5 FTU
An entire arm and hand = 4 FTU
An entire leg and foot = 8 FTU
Potencies (European)
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Weak
Moderate
Potent
Very potent
Potencies (American)
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Class1
Class2
Class3
Class4
Class5
Class6
Class7
(superpotent)
(potent)
(potent)
(midstrength)
(midstrength)
(mild)
(least potent)
Examples
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Weak
• Hydrocrtisone 0.5-2.5% (Alfacort,
Mycoheal with miconazole, Fucidin H
with fucidic acid)
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Moderate
• Clobetasone butyrate 0.05%
(Eumovate)
• Hydrocrtisone with urea (Carmol HC)
Examples
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Potent
• Mometasone dipropionate 0.025% or
furoate 0.1% (Elica, Elica M with
miconazole, Momenta with miconazol &
gentamycin)
• Betamethasone esters as valerate 0.1%
or diproprionate 0.05% (Betnovate,
Betaderm, Fucibact B with Fucidic acid,
Betazol with miconazole, Diprosalic with
salicylic acid)
Examples
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Potent (cont.)
• Hydrocortisone 17 butyrate 0.1%
(Locoid)
• Trimcinolone acetonide 0.1% (Panderm
with gentamycin, nystatin & neomycin)
Examples
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Very potent
• Clobetasol propionate 0.05%
(Dermovate, Gamavate)
• Diflucortolone valerate (Nerisone)
Side effects
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Perioral dermatitis and rosacea
Tachyphylaxis & steroid addiction
Infections (tinea incognito, herpes
simplex, pityriasis versicolor,
scabies……)
Adrenal suppression
Glucoma and cataract
Angina bullosa purpura (hard palate)
Side effects
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Local side effects
• Telangiectasia, purpura, epidermal, dermal and
subcutaneous atrophy, striae, psuedoscars……
• Folliculitis
• Allergic reactions
• Hypopigmentation
• Hypertrichosis
• Delayed wound healing
• Alteration in skin elasticity & mechanical
properties
Dermatitis due to topical steroid
Tinea incognito