Page 1 of 2
`
`www.medscape.com
`Use of Topical Corticosteroids for Dermatologic Conditions
`Reviewed
`Laurie Barclay, MD
`
`January 21, 2009
`
`To earn CME related to this news article, click here.
`
`January 21, 2009 — The best practices for choosing topical corticosteroids for patients with various dermatologic
`conditions are reviewed in the January 15 issue of American Family Physician.
`
`"The usefulness and side effects of topical steroids are a direct result of their anti-inflammatory properties, although
`no single agent has been proven to have the best benefit-to-risk ratio," write Jonathan D. Ference, PharmD, from
`Nesbitt College of Pharmacy and Nursing, Wilkes University in Wilkes-Barre, Pennsylvania, and Allen R. Last, MD,
`MPH, from Racine Family Medicine Residency Program, Medical College of Wisconsin, in Racine, Wisconsin.
`
`"Topical corticosteroids are effective for conditions that are characterized by hyperproliferation, inflammation, and
`immunologic involvement," Drs. Ference and Last write. "They can also provide symptomatic relief for burning and
`pruritic lesions."
`
`Topical corticosteroids have a long history of effectiveness in a wide spectrum of dermatologic conditions. Currently
`available topical steroids differ widely in potency and formulation. To safely and effectively treat steroid-responsive
`skin conditions, clinicians should become familiar with 1 or 2 agents in each category of potency.
`
`For successful treatment with topical steroids, factors to be considered include accurate diagnosis, delivery vehicle
`used for the steroid (eg, ointment, cream, gel, lotion, shampoo), potency, frequency of application, duration of
`treatment, and adverse effects.
`
`Despite frequent use of topical steroids, clinical data support efficacy only in certain dermatologic conditions. These
`include psoriasis, vitiligo, eczema, atopic dermatitis, phimosis, acute radiation dermatitis, and lichen sclerosus.
`
`To date, evidence is limited for use of topical steroids in melasma, chronic idiopathic urticaria, and alopecia areata.
`
`Topical steroid potency can be classified based on the vasoconstrictor assay, which evaluates the degree of
`cutaneous vasoconstriction ("blanching effect") in healthy persons. The 7 groups of topical corticosteroid potency
`range from ultrahigh potency (group 1) to low potency (group 7).
`
`High-potency topical corticosteroids (groups 1 - 3) include augmented betamethasone dipropionate 0.05% and
`clobetasol propionate 0.05%. These should be reserved for alopecia areata, resistant atopic dermatitis, discoid
`lupus, hyperkeratotic eczema, lichen planus, lichen sclerosus of the skin, lichen simplex chronicus, nummular
`eczema, severe poison ivy, psoriasis, and severe hand eczema.
`
`Except in rare situations and for short durations, high-potency and ultrahigh-potency steroids should not be used on
`the face, groin, axilla, or under occlusion.
`
`Medium-potency topical steroids (groups 4 and 5) may be used in severe anal inflammation, asteatotic eczema,
`atopic dermatitis, lichen sclerosus of the vulva, nummular eczema, scabies (after treatment with scabicide),
`seborrheic dermatitis, severe dermatitis, severe intertrigo (for short-term treatment), and stasis dermatitis. Examples
`of medium-potency topical steroids include betamethasone valerate, desoximetasone 0.05%, and fluocinolone
`acetonide 0.025%.
`
`Low-potency topical steroids (groups 6 and 7) may be effective in dermatitis of the diaper area, eyelids, or face;
`intertrigo; and perianal inflammation. Examples of low-potency topical steroids include fluocinolone 0.01%;
`hydrocortisone butyrate 0.1%; and hydrocortisone 1%, 2.5%. These agents are the safest for long-term use, for
`application over large surface areas, for use on the face or areas of the body with thinner skin, and for use in
`children.
`
`https://www.medscape.com/viewarticle/587159_print
`
`2/7/2018
`
`1
`
`AMN1027
`
`Mylan (IPR2019-01095) MYLAN1027, p. 001
`
`

`

`Page 2 of 2
`
`Most preparations should be applied once or twice daily, with the optimal dosing schedule determined by trial and
`error. Chronic application of topical corticosteroids may result in tolerance and tachyphylaxis. Ultrahigh-potency
`steroids should not be used for more than 3 weeks continuously, but if a longer duration is required, the steroid
`should be gradually tapered to avoid rebound symptoms, and treatment should be resumed after a steroid-free
`period of at least 1 week.
`
`Like systemic corticosteroids, topical corticosteroids may have potential adverse effects. Cutaneous or local adverse
`effects may include atrophic changes, easy bruisability, increased fragility, purpura, stellate pseudoscars, steroid
`atrophy, striae, telangiectasis, and ulceration.
`
`Topical corticosteroids may increase the risk for infections, including aggravation of cutaneous infection, granuloma
`gluteale infantum, masked infection (tinea incognito), and secondary infections.
`
`Miscellaneous adverse effects of topical corticosteroids may include contact dermatitis, delayed wound healing,
`hyperpigmentation, hypertrichosis (hirsutism), hypopigmentation, perioral dermatitis, and photosensitization.
`
`"Topically applied high- and ultra-high potency corticosteroids can be absorbed well enough to cause systemic side
`effects," the review authors write. "Hypothalamic-pituitary-adrenal suppression, glaucoma, septic necrosis of the
`femoral head, hyperglycemia, hypertension, and other systemic side effects have been reported. It is difficult to
`quantify the incidence of side effects caused by topical corticosteroids as a whole, given their differences in
`potency."
`
`Specific clinical recommendations for practice, all rated level of evidence C, are as follows:
`
`• Psoriasis, vitiligo, lichen sclerosus, atopic dermatitis, eczema, and acute radiation dermatitis can be treated
`with topical steroids.
`
`• Treatment duration with ultrahigh-potency topical steroids used continuously should not exceed 3 weeks.
`
`• To avoid adverse effects, continuous use of low-potency to high-potency topical steroids should not exceed 3
`months.
`
`• To lower the risk for tinea infections, clinicians should generally avoid combinations of topical steroids and
`antifungal agents.
`
`"Children often require a shorter duration of treatment and a lower potency steroid," the review authors conclude.
`"When the diagnosis is unclear, when standard treatments fail, or when allergy patch testing is unavailable in the
`physician's office, referral to a dermatologist is recommended."
`
`The review authors have disclosed no relevant financial relationships.
`
`Am Fam Physician. 2009;79:135-140.
`
`Medscape Medical News © 2009
`
`Cite this article: Laurie Barclay. Use of Topical Corticosteroids for Dermatologic Conditions
`Reviewed - Medscape - Jan 21, 2009.
`
`This website uses cookies to deliver its services as described in our Cookie Policy. By using this website, you agree to the
`use of cookies.
`close
`
`https://www.medscape.com/viewarticle/587159_print
`
`2/7/2018
`
`2
`
`Mylan (IPR2019-01095) MYLAN1027, p. 002
`
`