Fludrocortisone is NOT Used for Skin Conditions
Fludrocortisone is a mineralocorticoid used for adrenal insufficiency and orthostatic hypotension, NOT for dermatologic conditions like eczema or psoriasis. You may be confusing this with topical corticosteroids used in dermatology, which are entirely different medications.
Topical Corticosteroids for Psoriasis and Eczema
If you are asking about topical corticosteroids (not fludrocortisone) for skin conditions, here is the evidence-based approach:
Potency Selection Based on Disease and Location
Topical corticosteroids are the cornerstone of treatment for psoriasis and eczema, with selection based on disease severity and anatomic location 1.
For thick, chronic plaques on the body: Use ultra-high potency (Class 1) agents like clobetasol propionate 0.05% or halobetasol propionate 0.05%, with efficacy rates of 58-92% 2
For face, intertriginous areas, and genitals: Use only low potency (Classes 5-7) agents like hydrocortisone 1-2.5% due to high risk of skin atrophy in these steroid-sensitive sites 1, 2
For moderate disease on trunk and extremities: Use medium to high potency (Classes 2-4) agents like betamethasone dipropionate 0.05% or fluocinonide 0.05%, with efficacy rates of 68-74% 2
Duration and Application Strategy
More potent agents should be used short-term initially, then transitioned to intermittent use or lower potency agents for long-term management to minimize side effects 1.
Class 1 (ultra-high potency): Limit to 2-4 weeks of continuous use 1, 2
Classes 2-5 (medium to high potency): Can be used for up to 4 weeks for plaque psoriasis 2
After initial response: Gradually reduce frequency or switch to the least potent agent that maintains disease control 1
Application frequency: Typically 1-2 times daily 1
Combination and Maintenance Strategies
Combining topical corticosteroids with vitamin D analogues (calcipotriene) enhances efficacy and allows for reduced corticosteroid exposure 1.
Weekday/weekend regimen: Apply vitamin D analogues twice daily on weekdays with high-potency corticosteroids twice daily on weekends for maintenance 1
Morning/evening regimen: Apply high-potency corticosteroids in the morning and vitamin D analogues in the evening 1
Long-term combination: Calcipotriene plus betamethasone dipropionate can be used safely for up to 52 weeks without significant adverse events including striae or hypothalamic-pituitary-adrenal axis suppression 1
Important Precautions
Regular examinations are essential as unsupervised use of potent topical corticosteroids is not recommended 1
Local cutaneous side effects (skin atrophy, striae, telangiectasia) occur more frequently at steroid-sensitive sites 1, 2
Approximately 400g of topical agent is required to cover the entire body surface of an average adult when used twice daily for 1 week 1