Should We Use Mometasone?
Yes, mometasone furoate should be used as it is an effective, well-tolerated corticosteroid with proven efficacy across multiple conditions including dermatological disorders, allergic rhinitis, and chronic rhinosinusitis, with a favorable safety profile characterized by negligible systemic bioavailability and minimal risk of skin atrophy even with long-term use. 1, 2
Dermatological Applications
Atopic Dermatitis (Eczema)
- Mometasone furoate 0.1% ointment or fatty cream is recommended as first-line therapy, applied once daily until control is achieved, then transitioned to twice-weekly maintenance for up to 36 weeks with a 68% remission rate. 1, 2
- Combine with liberal application of fragrance-free emollients to the entire body at least once daily to restore skin barrier function 1
- For infected eczema, add flucloxacillin for Staphylococcus aureus before or concurrent with corticosteroid therapy 1
- Long-term safety is established: only 1 of 61 patients showed possible skin atrophy after 6 months of twice-weekly prophylactic treatment 3
Psoriasis
- For moderate to severe psoriasis with body surface area (BSA) ≤20%, mometasone with salicylic acid 5% is recommended 2, 4
- Mometasone ointment applied once daily is significantly more effective (p<0.01) than fluocinolone ointment three times daily and triamcinolone ointment twice daily 5
- The cream formulation is significantly more effective (p<0.001) than fluocinolone cream and equivalent to triamcinolone cream 5
Chronic Hand Eczema
- Daily treatment with mometasone furoate fatty cream until clearance (typically 3-9 weeks), followed by intermittent maintenance on Sunday/Tuesday/Thursday prevents recurrence in 83% of patients over 36 weeks 6
- This regimen is superior to weekend-only treatment (68% success) and vastly superior to no maintenance (26% success) 6
Pruritus (Including Cancer Treatment-Related)
- For mild or localized pruritus (Grade 1), apply topical moderate/high-potency steroids including mometasone furoate 0.1% ointment 7
- For Grade 2 pruritus (intense or widespread), continue mometasone OR add oral antihistamines OR GABA agonists (pregabalin/gabapentin) 7
- Reassess after 2 weeks; if no improvement, escalate therapy 7
Rhinological Applications
Allergic Rhinitis
- Mometasone furoate nasal spray is highly effective for both seasonal and perennial allergic rhinitis with onset of action within 7 hours 4, 8
- Dosing: Ages 2-11 years: 1 spray per nostril once daily; Ages ≥12 years: 2 sprays per nostril once daily 4
- Efficacy is equivalent to beclomethasone dipropionate twice daily and fluticasone propionate once daily, and superior to oral loratadine 8
Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)
- For adults with nasal polyps: 2 sprays per nostril twice daily 4
- Corticosteroid-eluting implants delivering 1350μg mometasone furoate in the ethmoid sinus reduce nasal obstruction (mean difference 0.28 on 0-3 scale), decrease polyp grade, and reduce need for surgery by 66% (OR 0.37) 7
- The implants are placed in-office for patients with recurrent polyposis after sinus surgery, with effects lasting approximately 90 days 7
Mometasone Irrigation
- Mometasone irrigation 2000μg in 240ml saline significantly favors symptom improvement, endoscopy scores, and CT scores compared to nasal spray at 12 months in postoperative CRS patients 7
Safety Profile
Systemic Effects
- Mometasone has negligible bioavailability and lower potential for systemic effects compared to other corticosteroids 2, 4
- No detectable effect on hypothalamic-pituitary-adrenal (HPA) axis function in studies up to 1 year duration 8
- Minimal adrenal suppression with topical use, comparable to betamethasone dipropionate 9
Local Effects
- Significantly less skin atrophy than betamethasone dipropionate; atrophy not observed before 4-12 weeks of treatment when it does occur 9
- Adverse events are generally mild to moderate and of limited duration 8
- Most common adverse events with intranasal use: nasal irritation/burning, headache, epistaxis, pharyngitis 8
Special Populations
Pediatric Use
- Topical lotion formulation is FDA-approved only for ages ≥12 years 10
- Intranasal formulation is approved for children as young as 2 years 4
- Avoid salicylic acid combinations in children due to increased risk of systemic absorption and toxicity 2, 4
- Children have higher risk of HPA axis suppression due to greater skin surface area to body mass ratio; use with caution when treating >20% body surface area 10
Pregnancy and Lactation
- Use during pregnancy only if potential benefit justifies potential risk to the fetus 10
- Exercise caution when administering to nursing women as systemic corticosteroids appear in human milk 10
- Moisturizers used with mometasone are considered safe during pregnancy and lactation 4
Practical Application Guidelines
Dosing and Administration
- Apply once daily and massage lightly until it disappears; discontinue when control is achieved 10
- If no improvement within 2 weeks, reassess diagnosis 10
- Do not use with occlusive dressings unless directed by physician 10
- Do not apply in diaper area as diapers/plastic pants constitute occlusive dressing 10
Common Pitfalls to Avoid
- Do not use euphrasia (eyebright) for eczema management—it has no evidence-based role 1
- Do not rely solely on oral antihistamines for itch control in atopic dermatitis; they have minimal benefit beyond sedation 1
- Avoid abrupt discontinuation after long-term use; taper to maintenance dosing 1, 2
- Do not overlook secondary bacterial infection in eczema; treat concurrently with appropriate antibiotics 1