What is the recommended treatment protocol for a patient with eczema, psoriasis, or dermatitis using desonide (a topical corticosteroid)?

Desonide Treatment Protocol for Eczema, Psoriasis, and Dermatitis

Primary Recommendation

Desonide 0.05% should be applied as a thin film 2-4 times daily to affected areas for up to 2-4 weeks, with the understanding that this low-potency (Class 6) topical corticosteroid is most appropriate for mild-to-moderate dermatoses, particularly on sensitive areas like the face and intertriginous regions. 1

Application Protocol

Dosing Frequency and Duration

• Apply 2-4 times daily depending on severity 1
• Discontinue therapy when control is achieved 1
• If no improvement within 2 weeks, reassess diagnosis 1
• Do not use with occlusive dressings 1

Anatomic Considerations

• Desonide is specifically indicated for face and intertriginous areas where higher-potency steroids carry excessive atrophy risk 2
• Lower potency corticosteroids like desonide should be used on areas susceptible to steroid atrophy (e.g., forearms) 2
• Avoid application to eyes 1

Disease-Specific Guidance

For Atopic Eczema/Dermatitis

• Use as part of first-line treatment alongside emollients and soap substitutes 2
• Apply emollients after bathing to maximize hydration, then apply desonide 2
• The basic principle is to use the least potent preparation required to keep eczema under control 2
• Short periods of treatment discontinuation should be attempted when possible 2
• Desonide demonstrated 88% clearance or near-clearance in facial atopic dermatitis over 3 weeks 3

For Psoriasis

• Desonide (Class 6) is NOT recommended as first-line therapy for plaque psoriasis on non-intertriginous areas 2
• For psoriasis, Class 1-5 corticosteroids are recommended for up to 4 weeks 2
• Desonide may be considered only for facial or intertriginous psoriasis where higher-potency agents are contraindicated 2

For Seborrheic Dermatitis

• Desonide 0.05% lotion showed 88% clearance rates in facial seborrheic dermatitis over 3 weeks 3
• Apply twice daily for short-term treatment (up to 3 weeks) 3

Safety Monitoring

HPA Axis Suppression Risk

• One in ten patients developed HPA axis suppression when desonide was used under occlusion on 30% of body surface for one week 1
• Monitor patients applying desonide to large surface areas for HPA axis suppression using ACTH stimulation, AM plasma cortisol, or urinary free cortisol tests 1
• Pediatric patients are more susceptible to systemic toxicity due to larger skin surface-to-body mass ratios 1
• However, desonide 0.05% ointment showed no HPA axis suppression in children with atopic dermatitis treated for 4 weeks 4

Local Adverse Effects

• Watch for skin atrophy, striae, folliculitis, telangiectasia, and purpura 2
• Face and intertriginous areas are at greatest risk 2
• If irritation develops, discontinue and institute appropriate therapy 1
• Allergic contact dermatitis with corticosteroids manifests as failure to heal rather than clinical exacerbation 1

Contraindications

• Do not use in presence of infection at treatment site 1
• Do not use with hypersensitivity to corticosteroids 1
• Do not use with pre-existing skin atrophy 1

Combination and Adjunctive Strategies

With Emollients

• Combine with emollients to reduce itching, desquamation, and prevent quick relapse when corticosteroids are discontinued 2
• Apply emollients after bathing for maximum effect 2

With Antibiotics (When Infection Present)

• Use flucloxacillin for S. aureus infection 2
• Use phenoxymethylpenicillin for β-hemolytic streptococci 2
• Use erythromycin for flucloxacillin resistance or penicillin allergy 2

Steroid-Sparing Approach

• For prolonged treatment needs, consider rotating to calcineurin inhibitors (tacrolimus, pimecrolimus) after initial control, particularly for facial and intertriginous areas 2
• Gradually reduce frequency after clinical improvement 2

Special Populations

Pediatric Use

• Desonide is safe in children, including infants less than 1 year of age 5
• No HPA axis suppression observed in children treated for 4 weeks 4
• Keep nails short to minimize excoriation 2

Pregnancy

• Pregnancy Category C 1
• Use only if potential benefit justifies potential fetal risk 1

Clinical Pearls

• 98.5% of patients showed improvement with desonide in a large post-marketing study of 1789 patients 5
• Both cream and lotion formulations are equally effective 5
• Hydrogel and foam preparations increase versatility and patient tolerability 6
• 95% of patients stated they would use desonide again, indicating high acceptability 3
• No serious adverse reactions directly attributable to desonide in pharmacovigilance data covering millions of prescriptions 7