What is the analysis of topical corticosteroid (steroid) ointment?

From the Guidelines

Topical steroid ointments are a highly effective treatment option for various skin conditions, including psoriasis, with ultra-high potency corticosteroids (class 1) showing efficacy rates ranging from 58% to 92% in randomized controlled trials (RCTs) 1. When analyzing topical steroid ointments, it's essential to consider their potency, vehicle, and potential side effects.

• Topical corticosteroids are classified into 7 categories based on their skin vasoconstrictive activity, ranging from ultra-high (class 1) to low (class 6 and 7) 1.
• The choice of corticosteroid potency and vehicle should be based on disease severity, location, patient preference, and age 1.
• Lower potency corticosteroids are recommended for use on the face, intertriginous areas, and areas susceptible to steroid atrophy, while ultra-high potency corticosteroids (class 1) are often required for areas with thick, chronic plaques 1.
• In adults, corticosteroids in classes 2 through 5 (moderate to high potency) are generally recommended as initial therapy, with ultra-high potency corticosteroids reserved for more severe cases 1.
• Common side effects of topical steroid use include skin thinning, striae, telangiectasia, and adrenal suppression with extensive application, emphasizing the need to use the lowest effective potency and follow proper dosing guidelines 1.
• The "fingertip unit" measurement (approximately 0.5g) can be used to ensure appropriate dosing and minimize risks associated with topical steroid use 1.

From the FDA Drug Label

CLINICAL PHARMACOLOGY Topical corticosteroids share anti-inflammatory, antipruritic and vasoconstrictive actions. The mechanism of anti-inflammatory activity of the topical corticosteroids is unclear. Various laboratory methods, including vasoconstrictor assays, are used to compare and predict potencies and/or clinical efficacies of the topical corticosteroids There is some evidence to suggest that a recognizable correlation exists between vasoconstrictor potency and therapeutic efficacy in man.

The topical steroid ointment, specifically triamcinolone, has anti-inflammatory, antipruritic, and vasoconstrictive properties.

• The mechanism of action is not fully understood, but it is thought to be related to its ability to reduce inflammation and suppress the immune system.
• The potency of topical corticosteroids, including triamcinolone, can be measured using vasoconstrictor assays, which can predict their clinical efficacy 2.
• The pharmacokinetics of topical corticosteroids involve percutaneous absorption, which can be increased by factors such as inflammation and occlusive dressings 2.
• Key points about topical steroid ointment include:
  • Anti-inflammatory effects
  • Antipruritic effects
  • Vasoconstrictive effects
  • Unclear mechanism of action
  • Variable potency depending on the specific corticosteroid and individual patient factors 2

From the Research

Topical Steroid Ointment Analysis

• Topical corticosteroids are an essential tool for treating inflammatory skin conditions such as psoriasis and atopic dermatitis 3
• They are classified by strength and the risk of adverse effects such as atrophy, striae, rosacea, telangiectasias, purpura, and other cutaneous and systemic reactions 3
• The risk of adverse effects increases with prolonged use, a large area of application, higher potency, occlusion, and application to areas of thinner skin such as the face and genitals 3

Efficacy and Safety

• Potent and/or very potent topical steroids, tacrolimus 0.1%, and ruxolitinib 1.5% are among the most effective treatments for improving patient-reported symptoms and clinician-reported signs 4, 5
• Local application site reactions are most common with tacrolimus 0.1% and crisaborole 2%, and least common with topical steroids 4, 5
• Skin thinning is not increased with short-term use of any topical steroid potency, but skin thinning was reported in 6/2044 (0.3%) participants treated with longer-term topical steroids 4, 5

Comparison with Other Treatments

• Topical corticosteroids are more effective in decreasing inflammation than tacrolimus, but tacrolimus improves skin hydration more than topical corticosteroids 6
• Tacrolimus 0.1% and crisaborole 2% are ranked most likely to cause local application-site reactions, and topical corticosteroids are least likely 5

Current and Future Treatments

• Current treatments for atopic dermatitis provide disease control, but patients struggle to find an optimized therapeutic regimen they may use long term and without severe effects 7
• Novel therapies are currently under investigation, with the hope of shifting the paradigm of atopic dermatitis management from symptom control to disease eradication 7