It also reduces the need for chronic treatment and makes it more likely that the patient will use it only when needed. Using a more potent topical corticosteroid will reduce the likelihood that the patient will require systemic corticosteroids. The more effective the medication, the less time needed for healing. Explain to your patient to apply just a small amount and rub it gently into the skin until it disappears. Prescribe the correct amount needed to cover the surface area once or twice a day until the next appointment and control the number of repeats. Growth retardation has been reported in children with atopic dermatitis. 10 Mild to moderately potent topicals almost never suppress adrenal function. However, once the medication is discontinued recovery is rapid. Children have a larger surface area to weight ratio allowing more absorption compared to adults. Her adrenal function remained normal.Īdrenal suppression can occur when large areas of the body are treated with potent topical corticosteroids. This reduces the risk of adrenal suppression.Īlso, normal skin is a better barrier and metabolizes more drug than diseased skin, so as the skin disease improves, absorption is decreased substantially – a built in safety net! An example of this was a sixteen-year-old girl with widespread striae over her arms and legs as a result of applying clobetesol propionate cream daily for two years to prevent her eczema from recurring. This is because skin cells metabolize corticosteroid before it can be absorbed, meaning the amount of active drug entering the circulation is much less than the amount applied. It is also safer to use potent or super potent topical corticosteroids even over a large area than using the systemic drug. Although they receive systemic steroids for their disease, the discoid skin lesions will often only resolve with addition of a potent topical corticosteroid. An example of this are patients with systemic lupus who have discoid skin lesions. The more acute and severe, the more potent the drug should be.ĭownload PDF of Appendix 1, Table 1, and Table 2.īecause topical corticosteroids are applied directly onto the diseased skin, efficacy is enhanced, and the risk of systemic side effects is markedly reduced. As the disease becomes less severe, you may reduce the potency of the steroid molecule. It is best to start treatment with a more potent corticosteroid rather than a mild less effective one. Creams spread more easily are more cosmetically acceptable.Ĭheck Table 1 (The site on the body affects percutaneous absorption) and Table 2 (Potency rankings of some of the commonly used topical corticosteroids) for help in deciding which corticosteroid molecule to use on a particular area. An ointment is the most effective vehicle especially on dry skin. The effectiveness of a topical corticosteroid is equally dependent upon the potency of the corticosteroid molecule and the type of vehicle used to transport the drug into the skin.
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