From the Guidelines
Topical steroid ointments work by exerting anti-inflammatory, antiproliferative, immunosuppressive, and vasoconstrictive effects via intracellular corticosteroid receptors, which regulate gene transcription, including several that code for proinflammatory mediators. The mechanism of action of topical steroid ointments involves binding to glucocorticoid receptors in skin cells, which then suppresses the production of inflammatory chemicals, decreasing the activity of immune cells that contribute to inflammation 1.
Key Effects of Topical Steroid Ointments
- Anti-inflammatory effects: reducing redness and swelling
- Antiproliferative effects: slowing down the growth of skin cells
- Immunosuppressive effects: suppressing the immune system's response
- Vasoconstrictive effects: narrowing of blood vessels, which reduces redness and swelling These effects are crucial in the treatment of psoriasis and other skin conditions, as they help to reduce inflammation, itching, and redness.
Choosing the Right Topical Steroid Ointment
The choice of topical steroid ointment should be based on the disease severity, disease location, patient preference, and the age of the patient 1.
- Lower potency corticosteroids should be used on sensitive areas like the face and intertriginous areas
- Higher potency corticosteroids are generally recommended as initial therapy for adults with moderate to severe plaque psoriasis
- Ultrahigh-potency corticosteroids may be necessary for areas with thick, chronic plaques.
From the FDA Drug Label
The corticosteroids are a class of compounds comprising steroid hormones secreted by the adrenal cortex and their synthetic analogs. In pharmacologic doses, corticosteroids are used primarily for their anti-inflammatory and/or immunosuppressive effects Topical corticosteroids such as clobetasol propionate are effective in the treatment of corticosteroid-responsive dermatoses primarily because of their anti-inflammatory, antipruritic, and vasoconstrictive actions. Topical corticosteroids share anti-inflammatory, antipruritic and vasoconstrictive actions.
The mechanism of action (MOA) of topical steroid ointment is primarily through their anti-inflammatory, antipruritic, and vasoconstrictive effects 2 3.
- Anti-inflammatory effects reduce inflammation and swelling
- Antipruritic effects relieve itching and scratching
- Vasoconstrictive effects reduce blood flow to the affected area, decreasing inflammation and swelling.
From the Research
Mechanism of Action of Topical Steroid Ointment
- Topical corticosteroids modify the functions of epidermal and dermal cells and of leukocytes participating in proliferative and inflammatory skin diseases 4
- After passage through the cell membrane, corticosteroids react with receptor proteins in the cytoplasm to form a steroid-receptor complex, which then binds to DNA and changes the transcription of messenger RNA (mRNA) 4
- This process can either stimulate or inhibit the synthesis of specific proteins, such as lipocortin, which inhibits the activity of phospholipase A2 and reduces the production of prostanoids and leukotrienes 4
- Corticosteroids also inhibit mRNA responsible for interleukin-1 formation, producing anti-inflammatory, immunosuppressive, and anti-mitogenic effects 4
Effects on Skin Conditions
- Topical corticosteroids are effective in treating inflammatory skin conditions such as psoriasis and atopic dermatitis 5, 6, 7
- They can reduce lesion size and improve treatment response in conditions like oral lichen planus 8
- However, long-term use of topical corticosteroids can lead to adverse effects such as skin atrophy, striae, and rosacea 5, 6
Comparison with Other Treatments
- Topical corticosteroids are compared to topical calcineurin inhibitors (TCI) in terms of efficacy and adverse effects 6, 7
- TCI, such as tacrolimus, may have greater treatment efficacy than weak topical corticosteroids, especially on thin or intertriginous skin regions 7
- However, the efficacy of moderate, potent, and very potent topical corticosteroids compared to TCI is less clear due to limited studies 7