Glucorticosteroids topical

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Corticosteroids; Cortisone allergy; Glucocorticoidexterna; Glucocorticoid Externum; Glucocorticoids topical; Glucocorticoids, topical; Glucorticosteroids topical; Topical corticosteroids; topical steroids; Topical steroids

Definition
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Glucocorticoids for topical application.

Classification
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Overview of topical glucocorticoids (monopreparations, classification according to Niedner, modified)

Class I (mild)

  • dexamethasone (0.02-0.05%)
  • Clobetasone butyrate (0.05%)
  • hydrocortisone (0.25%-1.0%)
  • hydrocortisone acetate (0.25-1.0%)
  • prednisolone (0.4-0.5%)

Class II (moderately strong)

  • Betamethasone valerate(0.05%)
  • deoximetasone (0.25%)
  • flumethasone (0.02%)
  • Flumetasone pivalate (0.02%)
  • fluocortolone (0.25%)
  • Flupredniden-21-acetat (0,1-2,5%)
  • Hydrocortisone 17-butyrate (0.1%)
  • Hydrocortisone aceponate (0.1%)
  • Hydrocortisone buteprate (0.1%)
  • prednicarbate (0.25%)
  • triamcinolone acetonide (0.05-0.1%)
  • dexamethasone (0.1%)

Class III (strong)

  • amcinonide (0.1%)
  • betamethasone 17,21-dipropionate (0,05%)
  • Betamethasone 17-valerate (0.1%)
  • deoximetasone (0.05%)
  • diflorasone diacetate (0.01%)
  • diflucortolone-21-pentanoate (0.1%)
  • Fluocinolone acetonide (0,025- 0,1 %)
  • Fluticasone propionate (0.025-0.1%)
  • Mometasone furoate (0.1%)

Class IV (very strong)

  • Clobetasol propionate (0.05%)
  • Diflucortolone valerate (0.3%)

Indication
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Inflammatory dermatoses, especially eczema diseases and localized forms of psoriasis vulgaris.

Limited indication
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Pregnancy, first trimester, nursing, diaper rash.

Dosage and method of use
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Depending on the concentration of the topical glucocorticoid and the indication1-3 times/day, apply thinly to the affected skin areas. On palms of hands and soles of feet, application under hourly (2-4h) occlusion is recommended. An intermittent maintenance therapy prolongs the remission times.

Undesirable effects
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Allergic reactions, glaucoma with prolonged use around the eyes, purpura, Cushing's syndrome, acne, infections, perioral dermatitis, folliculitis, skin atrophy, striae cutis distensae, skin dryness, hypertrichosis, wound healing disorders.

Contact allergic reactions are observed (Wurpts G 2018). According to an older European study, their incidence is (amazing!) 0.2-5.0%. 85% of these patients are sensitized to more than one glucocorticoid (Wurpts G 2018).

Topical glucocorticoids are divided into 4 groups according to their allergological relevance (see also glucocorticoid epicutaneous test series):

  • A (hydrocortisone type)
  • B (acetonide type)
  • C (betamethasone type)
  • D (ester type - esterifications in the C16 position)

Halogenation in C6 position reduces the risk of sensitization. Moderate sensitization accumulations are found with amcinonide, hydrocortisone-17-butyrate and budesonide.


Interactions
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With simultaneous application of idoxuridine delay of wound healing.

Contraindication
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Perioral dermatitis, bacterial skin inflammations (monotherapy), skin tuberculosis, vaccination reactions, syphilis, mycoses, rosacea, varicella.

Note(s)
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  • An application in the facial area should only be carried out under strict indication.
  • In case of large-area application a not inconsiderable systemic resorption has to be expected especially in case of inflammatory dermatoses.
  • Important for histological clarification of inflammatory dermatoses: in order to obtain relevant statements, external glucocorticoids have to be discontinued for several days (7-10 days) beforehand as otherwise an assessment is not very meaningful.
  • Different topical glucocorticoids can be combined with topical antibiotics or topical antiseptics (see below glucocorticoids topical, combinations).

Literature
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  1. Castela E et al (2012) Topical corticosteroids in plaque psoriasis: a systematic review of risk of adrenal axis suppression and skin atrophy. J Eur Acad Dermatol Venereol 26: Suppl 3, 47-51
  2. Dooms-Goossens A et al (1996) Corticosteroid contact allergy: an EECDRG multicentre study. Contact dermatitis 35:40-44.
  3. Goossens A (2000) Reactions to corticosteroids: some new aspects regarding cross-sensitivity. Cutis 65:43-45.
  4. Wurtps G (2018) Contact allergy to glucocorticoids. Allergo J 27: 13-15

Authors

Last updated on: 29.10.2020