corticosteroids (topical)

alclometasone: al-kloe-MET-a-sone

amcinonide: am-SIN-oh-nide

betamethasone: bay-ta-METH-a-sone

clobetasol: kloe-BAY-ta-sol

clocortolone: kloe-KORE-toe-lone

desonide: DES-oh-nide

desoximetasone: dess-ox-i-MET-a-sone

diflorasone: dye-FLOR-a-sone

fluocinolone: floo-oh-SIN-oh-lone

fluocinonide: floo-oh-SIN-oh-nide

flurandrenolide: flure-an-DREN-oh-lide

fluticasone: floo-TI-ka-sone

halcinonide: hal-SIN-oh-nide

halobetasol: hal-oh-BAY-ta-sol

hydrocortisone: hye-droe-KOR-ti-sone

mometasone: moe-MET-a-sone

triamcinolone: trye-am-SIN-oh-lone

Classifications ⬆ ⬇

Therapeutic Classification: corticosteroids

Pharmacologic Classification: corticosteroids (topical)

Indications ⬆ ⬇

REMS

Moderate to severe plaque psoriasis.
Inflammation and pruritus associated with corticosteroid-responsive dermatoses.

Action ⬆ ⬇

Suppress normal immune response and inflammation.

Therapeutic effects:

Suppression of dermatologic inflammation and immune processes.
Clearing of plaques

Pharmacokinetics ⬆ ⬇

Absorption: Minimal. Prolonged use on large surface areas, application of large amounts, or use of occlusive dressings may ↑ systemic absorption.

Distribution: Remain primarily at site of action.

Metabolism/Excretion: Usually metabolized in skin; some have been modified to resist local metabolism and have a prolonged local effect.

Half-Life: Betamethasone: 3–5 hr (plasma), 36–54 hr (tissue); dexamethasone: 3–4.5 hr (plasma), 36–54 hr (tissue); hydrocortisone: 1.5–2 hr (plasma), 8–12 hr (tissue); triamcinolone: 2–>5 hr (plasma), 18–36 hr (tissue).

Time/Action Profile ⬆ ⬇

( response depends on condition being treated)

ROUTE	ONSET	PEAK	DURATION
Topical	min–hr	hr–days	hr–days

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity or known intolerance to corticosteroids or components of vehicles (ointment or cream base, preservative, alcohol);
Untreated bacterial or viral infections.

Use Cautiously in:

Hepatic impairment;
Diabetes mellitus, cataracts, glaucoma, or tuberculosis (use of large amounts of high-potency agents may worsen condition);
Patients with pre-existing skin atrophy;
OB: Chronic use at high dosages may result in adrenal suppression in mother and growth suppression in children;
Pedi: Children may be more susceptible to adrenal and growth suppression. Clobetasol not recommended for children <18 yr (cream, lotion, shampoo, spray) or <12 yr (foam, gel, ointment, solution); desoximetasone not recommended for children <10 yr (cream, ointment, gel) or <18 yr (spray); halobetasol not recommended for children <12 yr.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: allergic contact dermatitis, atrophy, burning, dryness, edema, folliculitis, hypersensitivity reactions, hypertrichosis, hypopigmentation, irritation, maceration, miliaria, perioral dermatitis, secondary infection, striae

EENT: cataracts, glaucoma

Endo: adrenal suppression (↑ dose, long-term therapy)

Interactions ⬆ ⬇

Drug-drug:

None significant.

Route/Dosage ⬆ ⬇

(Adults and Children ): 1–4 times daily (depends on product, preparation, and condition being treated).
Rect (Adults ): hydrocortisoneAerosol foam: 90 mg 1–2 times/day for 2–3 wk; then adjusted.

Availability ⬆ ⬇

Alclometasone

(Generic available)

Cream: 0.05%
Ointment: 0.05%

Amcinonide

(Generic available)

Cream: 0.1%
Lotion: 0.1%
Ointment: 0.1%

Betamethasone

(Generic available)

Aerosol foam: 0.12%
Cream: 0.05%; 0.1%
Gel: 0.05%
Lotion: 0.05%; 0.1%
Ointment: 0.05%; 0.1%
Spray: 0.05%
In combination with:
calcipotriene (Enstilar, Taclonex, Wynzora), clotrimazole (Lotrisone); see Combination Drugs.

Clobetasol

(Generic available)

Cream: 0.025%; 0.05%
Foam: 0.05%
Gel: 0.05%
Lotion: 0.05%
Ointment: 0.05%
Scalp solution: 0.05%
Shampoo: 0.05%
Spray: 0.05%

Clocortolone

(Generic available)

Cream: 0.1%

Desonide

(Generic available)

Cream: 0.05%
Foam: 0.05%
Gel: 0.05%
Lotion: 0.05%
Ointment: 0.05%

Desoximetasone

(Generic available)

Cream: 0.05%; 0.25%
Gel: 0.05%
Ointment: 0.05%; 0.25%
Spray: 0.25%

Diflorasone

(Generic available)

Cream: 0.05%
Ointment: 0.05%

Fluocinolone

(Generic available)

Cream: 0.01%; 0.025%
Oil: 0.01%
Ointment: 0.025%
Solution: 0.01%
In combination with:
hydroquinone and tretinoin (Tri-Luma); neomycin (Neo-Synalar). See Combination Drugs.

Fluocinonide

(Generic available)

Cream: 0.05%; 0.1%
Gel: 0.05%
Ointment: 0.05%
Solution: 0.05%

Flurandrenolide

(Generic available)

Lotion: 0.05%
Ointment: 0.05%
Tape: 4 mcg/cm²

Fluticasone

(Generic available)

Cream: 0.05%
Lotion: 0.05%
Ointment: 0.005%

Halcinonide

(Generic available)

Cream: 0.1%
Ointment: 0.1%
Solution: 0.1%

Halobetasol

(Generic available)

Cream: 0.05%
Foam: 0.05%
Lotion: 0.01%; 0.05%
Ointment: 0.05%
In combination with:
tazarotene (Duobrii). See Combination Drugs.

Hydrocortisone

(Generic available)

Cream: 0.1%; 0.2%; 0.5%^{Rx, OTC}; 1%^{Rx, OTC}; 2.5%
Gel: 2%^{Rx, OTC}
Lotion: 0.1%; 1%^{Rx, OTC}; 2%
Ointment: 0.1%; 0.2%; 0.5%^{Rx, OTC}; 1%^{Rx, OTC}; 2.5%
Rectal cream: 1%; 2.5%
Solution: 0.1%; 1%; 2.5%
In combination with:
acetic acid, antifungals, anti-infectives, antihistamines, urea, and benzoyl peroxide in various otic and topical preparations. See Combination Drugs.

Mometasone

(Generic available)

Cream: 0.1%
Ointment: 0.1%
Lotion: 0.1%
Solution: 0.1%

Triamcinolone

(Generic available)

Cream: 0.025%; 0.1%; 0.5%
Lotion: 0.025%; 0.1%
Ointment: 0.025%; 0.05%; 0.1%; 0.5%
Spray: 0.147 mg/g
In combination with:
acetic acid, antifungals, anti-infectives, antihistamines, urea, and benzoyl peroxide in various otic and topical preparations. See Combination Drugs.

Assessment ⬆ ⬇

Assess affected skin before and daily during therapy. Note degree of inflammation, pruritus, and/or plaques. Notify health care provider if symptoms of infection (↑ pain, erythema, purulent exudate) develop.

Lab Test Considerations:

Adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in long-term topical therapy. Children and patients with dose applied to a large area, using an occlusive dressing, or using high-potency products are at highest risk for HPA suppression.
- May ↑ serum and urine glucose concentrations if significant absorption occurs.

Implementation ⬆ ⬇

Choice of vehicle depends on site and type of lesion. Ointments are more occlusive and preferred for dry, scaly lesions. Creams should be used on oozing or intertriginous areas, where the occlusive action of ointments might cause folliculitis or maceration. Creams may be preferred for esthetic reasons even though they may dry skin more than ointments. Gels, aerosols, lotions, and solutions are useful in hairy areas.
Topical Apply ointments, creams, or gels sparingly as a thin film to clean, slightly moist skin. Wear gloves. Apply occlusive dressing only if specified by health care provider.
- Apply lotion, solution, or gel to hair by parting hair and applying a small amount to affected area. Rub in gently. Protect area from washing, clothing, or rubbing until medication has dried. Hair may be washed as usual but not right after applying medication.
- Use aerosols by shaking well and spraying on affected area, holding container 3–6 inches away. Spray for about 2 sec to cover an area the size of a hand. Do not inhale. If spraying near face, cover eyes.
- Shake Sernivo spray before using. Spray affected area and rub in gently. Discontinue if control not achieved or after 4 wk of use.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
Advise patient on correct technique of medication administration. Emphasize importance of avoiding the eyes. Apply missed doses as soon as remembered unless almost time for the next dose.
Advise patient to use only as directed. Avoid using cosmetics, bandages, dressings, or other skin products over the treated area unless directed by health care provider.
Advise patient to consult health care provider before using medicine for condition other than indicated.
Advise patient to inform health care provider if symptoms of underlying disease return or worsen or if symptoms of infection develop.
Fluticasone: Advise patient to avoid excessive natural or artificial exposure (tanning booth, sun lamp) to areas where lotion is applied.
Pedi: Advise parents/caregivers of pediatric patients not to apply tight-fitting diapers or plastic pants on a child treated in the diaper area; these garments work as an occlusive dressing and may cause more of the drug to be absorbed.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding. Advise women of reproductive potential that medication should not be used extensively, in large amounts, or for protracted periods if they are pregnant or planning to become pregnant.

Evaluation/Desired Outcomes ⬆ ⬇

Suppression of dermatologic inflammation and immune processes.
Clearing of plaques.

US Brand Names ⬆ ⬇

alclometasone: ~~Aclovate,~~

betamethasone: Diprolene, ~~Diprolene AF,~~ Sernivo,

clobetasol: Clobex, Clodan, Impoyz, Olux-E, ~~Temovate,~~ ~~Temovate E,~~ Tovet,

clocortolone: Cloderm,

desonide: Tridesilon, Verdeso,

desoximetasone: Topicort,

diflorasone: Apexicon E,

fluocinolone: Derma-Smoothe/FS, Synalar,

fluocinonide: Vanos,

flurandrenolide: Cordran, ~~Cordran SP,~~

fluticasone: ~~Cutivate,~~

halcinonide: Halog,

halobetasol: Bryhali, Ultravate,

hydrocortisone: Ala-Cort, Ala-Scalp, Anusol HC, Cortaid, Cortifoam, Locoid, Texacort,

mometasone: ~~Elocon,~~

triamcinolone: Kenalog, Triderm, Tritocin

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆ ⬇

Canadian Brand Names ⬆