From the Guidelines
For facial atopic dermatitis, a medium potency topical corticosteroid such as triamcinolone acetonide 0.025% cream is not the most appropriate, instead mometasone furoate 0.1% ointment is too potent, betamethasone dipropionate augmented cream 0.05% is also too potent, and fluocinonide 0.05% cream is not the best option, the most appropriate selection would be a low to medium potency corticosteroid, but given the options, triamcinolone acetonide 0.025% cream would be the least potent of the options provided and thus the most appropriate for the face. When managing atopic dermatitis on the face, it's crucial to balance efficacy with the potential for adverse effects, given the delicate nature of facial skin 1.
- The face is a sensitive area, and high-potency corticosteroids can lead to significant side effects such as skin thinning, telangiectasia, and hypopigmentation.
- Medium potency steroids like triamcinolone acetonide 0.025% cream can be utilized for longer courses due to a more favorable adverse event profile 1.
- Maintenance therapy with intermittent use of medium potency topical corticosteroids, such as twice weekly application, can reduce disease flares and relapse 1.
- It's essential to advise patients to avoid triggers, maintain skin hydration with regular moisturizer application, and use gentle, fragrance-free cleansers.
- If the condition worsens or doesn't improve within two weeks, reevaluation is necessary to consider alternative treatments or referral to a dermatologist.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Like other topical corticosteroids, mometasone furoate has anti-inflammatory, anti-pruritic, and vasoconstrictive properties. Studies performed with Mometasone Furoate Lotion (Mometasone Furoate Topical Solution USP 0. 1%) indicate that it is in the medium range of potency as compared with other topical corticosteroids. Sixty-five pediatric patients ages 6 to 23 months, with atopic dermatitis, were enrolled in an open-label, hypothalamic-pituitary-adrenal (HPA) axis safety study. Mometasone Furoate Lotion (Mometasone Furoate Topical Solution USP 0. 1%) was applied once daily for approximately 3 weeks over a mean body surface area of 40% (range 16% to 90%).
The most appropriate topical corticosteroid to prescribe for a patient with atopic dermatitis covering the right side of her face is Mometasone furoate 0.1% ointment. This is because mometasone furoate has anti-inflammatory, anti-pruritic, and vasoconstrictive properties, and studies have shown it to be in the medium range of potency as compared with other topical corticosteroids, making it a suitable option for treating atopic dermatitis 2.
- Key points:
- Mometasone furoate has anti-inflammatory properties
- It is in the medium range of potency
- Suitable for treating atopic dermatitis
- Applied once daily
- Over a mean body surface area of 40% (range 16% to 90%) in pediatric patients with atopic dermatitis.
From the Research
Topical Corticosteroid Options for Atopic Dermatitis
The patient presents with atopic dermatitis covering the right side of her face, and the most appropriate topical corticosteroid needs to be selected. The options provided are:
- Betamethasone dipropionate augmented cream 0.05%
- Mometasone furoate 0.1% ointment
- Triamcinolone acetonide 0.025% cream
- Fluocinonide 0.05% cream
Efficacy and Safety of Topical Corticosteroids
Studies have shown that mometasone furoate 0.1% is effective in the treatment of atopic dermatitis, with a low potential for adverse systemic effects and a low atrophogenic potential 3, 4, 5. Mometasone furoate has been compared to other topical corticosteroids, such as betamethasone valerate and triamcinolone acetonide, and has been found to be as effective or more effective in the treatment of atopic dermatitis and other dermatoses 3, 5, 6.
Comparison of Topical Corticosteroids
A study comparing mometasone furoate 0.1% to fluocinolone acetonide 0.025% and triamcinolone acetonide 0.1% in the treatment of psoriasis found that mometasone furoate was significantly more effective than fluocinolone acetonide and equivalent to triamcinolone acetonide 6. Another study found that triamcinolone acetonide 0.05% with laurocapram was effective in the treatment of atopic dermatitis, but this formulation is not among the options provided 7.
Most Appropriate Selection
Based on the evidence, the most appropriate selection for an APN to prescribe for a patient with atopic dermatitis covering the right side of her face would be:
- Mometasone furoate 0.1% ointment, due to its efficacy and safety profile, as well as its low potential for adverse systemic effects and atrophogenic potential 3, 4, 5, 6. Key points to consider:
- Mometasone furoate 0.1% has been shown to be effective in the treatment of atopic dermatitis
- Mometasone furoate has a low potential for adverse systemic effects and a low atrophogenic potential
- Mometasone furoate is as effective or more effective than other topical corticosteroids, such as betamethasone valerate and triamcinolone acetonide 3, 5, 6