From the Guidelines
Topical steroid creams are not recommended for long-term use in chronic urticaria due to potential side effects such as skin thinning and striae. For mild, localized hives, low to medium potency steroid creams like hydrocortisone 1% or triamcinolone 0.1% can be applied thinly to affected areas 2-3 times daily for short periods (1-2 weeks) 1. However, it's essential to note that oral antihistamines are the mainstay treatment for chronic urticaria, with options like cetirizine (10mg daily), fexofenadine (180mg daily), or loratadine (10mg daily) 1. Some key points to consider when managing chronic urticaria include:
- Identifying and avoiding triggers
- Using gentle soaps
- Wearing loose clothing
- Applying cool compresses
- Considering alternative treatments like montelukast, doxepin, or omalizumab injections if antihistamines are insufficient 1. It's crucial to prioritize the patient's quality of life and minimize potential side effects when selecting a treatment plan for chronic urticaria.
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.
Chronic Urticaria Treatment:
- Clobetasol propionate is a topical corticosteroid that can be used to treat corticosteroid-responsive dermatoses.
- The drug label does not explicitly mention chronic urticaria as an indication for clobetasol propionate.
- However, given its anti-inflammatory and antipruritic properties, it may be considered for the treatment of chronic urticaria, but with caution and under medical supervision 2.
From the Research
Treatment Options for Chronic Urticaria
- The current guidelines recommend non-sedating, second-generation H1-antihistamines (nsAHs) as the first-line treatment for chronic urticaria 3.
- If needed, nsAHs are to be used at higher doses (up to fourfold the standard dose) 3, 4, 5.
- For patients who do not respond to standard doses of non-sedating antihistamines, increasing the dose of non-sedating antihistamines may represent the safest therapeutic approach 5.
- Other therapeutic options for chronic urticaria include Omalizumab, Montelukast, or Cyclosporin A as third-line options 3, and corticosteroids, which can be used effectively but with caution due to toxicity 6.
Use of Steroids in Chronic Urticaria
- Corticosteroids can be effective for antihistamine-resistant chronic spontaneous urticaria, but their use is limited by toxicity 6.
- If used at all, a dose of no more than 10 mg/day should be employed with a weekly reduction of 1 mg 6.
- There is no mention of steroid creams being used as a treatment option for chronic urticaria in the provided studies.
Alternative Treatments
- Other agents that can be tried for chronic urticaria include leukotriene antagonists, H2 receptor antagonists, and drugs effective for urticarial vasculitis, but these have limited utility and response rates 6.
- Omalizumab has been shown to be effective in treating chronic urticaria, with a response rate close to 75% 6, and has been recently approved by the US Food and Drug Administration for this indication 7.