What is the proper use of fluocinolone (Synalar)?

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Fluocinolone Acetonide Topical Oil, 0.01% for scalp psoriasis in adults: For the treatment of scalp psoriasis, wet or dampen hair and scalp thoroughly. Apply a thin film of Fluocinolone Acetonide Topical Oil, 0.01% on the scalp, massage well and cover scalp with the supplied shower cap. Leave on overnight or for a minimum of 4 hours before washing off. Wash hair with regular shampoo and rinse thoroughly.

Patients using topical corticosteroids should receive the following information and instructions:

1. This medication is to be used as directed by the physician. It is for external use only. Avoid contact with the eyes. In case of contact, wash eyes liberally with water. 2 This medication should not be used for any disorder other than that for which it was prescribed.
2. Patients should promptly report to their physician any worsening of their skin condition.
3. Parents of pediatric patients should be advised not to use Fluocinolone Acetonide Topical Oil, 0.01% in the treatment of diaper dermatitis.
4. This medication should not be used on the face, underarm, or groin unless directed by the physician.
5. As with other corticosteroids, therapy should be discontinued when control is achieved. If no improvement is seen within 2 weeks, contact the physician

Key Points for Using Fluocinolone:

• Use as directed by a physician
• For external use only
• Avoid contact with eyes
• Do not use for disorders other than prescribed
• Report worsening skin conditions to physician
• Avoid use on face, underarm, or groin unless directed by physician
• Discontinue therapy when control is achieved or after 2 weeks if no improvement is seen 1, 1

From the Research

Fluocinolone acetonide should be used as an insert, releasing 0.2 μg/day, to treat noninfectious intermediate, posterior, or panuveitis, as it has been shown to significantly reduce uveitis recurrence rates and improve visual acuity. This recommendation is based on the most recent and highest quality study available, which demonstrated the efficacy and safety of the fluocinolone acetonide insert in treating noninfectious uveitis of the posterior segment 2. The study found that the insert significantly reduced uveitis recurrence rates, improved visual acuity, and reduced the need for adjunctive treatments.

Key Considerations

• The fluocinolone acetonide insert is a promising new therapy for the treatment of severe uveitis, with a sustained drug delivery system that can release the medication for at least 2.5 years 3.
• The insert has been shown to be effective in reducing uveitis recurrence rates, improving visual acuity, and reducing the need for adjunctive treatments 2.
• However, the insert is associated with an increased risk of cataract and glaucoma, and patients should be carefully monitored for these potential complications 4, 5.
• Systemic therapy may be indicated as the initial treatment for many bilateral uveitis cases, but implant therapy is a reasonable alternative, especially for unilateral cases and when systemic therapy is not feasible or is not successful 4.

Patient Selection

• Patients with noninfectious intermediate, posterior, or panuveitis who have not responded to systemic therapy or have significant side effects from systemic therapy may be candidates for the fluocinolone acetonide insert.
• Patients with a history of cataract or glaucoma should be carefully evaluated before receiving the insert, as they may be at increased risk for these complications.

Monitoring and Follow-up

• Patients receiving the fluocinolone acetonide insert should be carefully monitored for potential complications, including cataract and glaucoma.
• Regular follow-up appointments should be scheduled to assess the effectiveness of the treatment and to monitor for potential side effects.