From the Guidelines
Topical corticosteroids (steroids) are the cornerstone of treatment for inflammatory skin conditions, such as atopic dermatitis, and are used to decrease the inflammatory immune response.
Key Characteristics of Topical Corticosteroids
- They can be grouped into seven potency classes 1, with high potency steroids being used with caution in sensitive skin areas to avoid skin atrophy.
- Low to medium potency topical corticosteroids, such as fluticasone or mometasone, can be used for longer periods to treat chronic conditions involving the trunk and extremities 1.
- High potency topical corticosteroids should be used with caution in highly sensitive skin areas, such as the face, neck, and skin folds, to avoid skin atrophy.
Usage Guidelines
- Patients should be carefully instructed to ensure the prudent use of topical corticosteroids to avoid or minimize adverse effects 1.
- Reactive therapy with topical corticosteroids is usually applied once or twice daily until the lesions are significantly improved 1.
- Proactive therapy with twice-weekly application of low to medium potency topical corticosteroids may help to prevent relapses in children with moderate to severe atopic dermatitis 1.
- The basic principle is to use the least potent preparation required to keep the eczema under control, and when possible, the corticosteroids should be stopped for short periods 1.
From the Research
Definition and Use of Topical Corticosteroids
- Topical corticosteroids are one of the oldest and most useful treatments for dermatologic conditions 2
- They are commonly prescribed for skin problems encountered in primary care or dermatology clinic settings 3
- Topical corticosteroids are used primarily as monotherapy or in combination with other agents for enhanced efficacy 4
Types and Potency of Topical Corticosteroids
- There are many topical steroids available, and they differ in potency and formulation 2
- Several stronger preparations are now available, and they can be tailored for use based on specific anatomic locations, area of involvement, age of the patient, and severity of the condition 4
- The potency of topical corticosteroids can be altered by the vehicle used, and different vehicles can be chosen for specific skin conditions 2, 4
Conditions Treated with Topical Corticosteroids
- Topical corticosteroids are effective in treating conditions such as psoriasis, vitiligo, eczema, atopic dermatitis, phimosis, acute radiation dermatitis, and lichen sclerosus 2
- They can also be used to treat other conditions, including melasma, chronic idiopathic urticaria, and alopecia areata, although evidence for these conditions is limited 2
Side Effects and Risks of Topical Corticosteroids
- Topical corticosteroids can cause local and systemic side effects, including allergic contact dermatitis, skin atrophy, and suppression of cell proliferation 5, 4, 6
- The risk of side effects can be reduced by considering factors such as the intrinsic potency of the drug, type of vehicle used, and frequency of application 6
- Judicious use and reinforced patient education can also lower the risk of side effects 4