TeacherOfMedicine: Corticosteroids (glucocorticoids), topical

Used in inflammatory skin conditions, e.g. eczema, to treat disease flares or to control chronic disease where emollients alone are ineffective.

Corticosteroids have immunosuppressive, metabolic and mineralocorticoid effects, as discussed in detail under Corticosteroids (glucocorticoids), systemic. Where corticosteroids are applied topically, effects are mostly limited to the site of application. With potent or prolonged use of topical corticosteroids, systemic absorption and effects can occur.
Topical corticosteroids can be classified as being mild, moderately potent, potent and very potent, depending on the type and concentration of corticosteroid in the formulation. Of the examples given, hydrocortisone 0.1–2.5 is mild and betamethasone valerate 0.1% is potent.

Adverse effects are uncommon with mild or moderately potent topical corticosteroids. However, potent and very potent topical corticosteroids can cause local adverse effects such as skin thinning, striae, telangiectasia and contact dermatitis. When used on the face, they can cause perioral dermatitis and cause or exacerbate acne. Withdrawal of topical corticosteroids can cause a rebound worsening of the underlying skin condition. Rarely, adrenal suppression and systemic adverse effects occur (see Corticosteroids (glucocorticoids), systemic).

You should not use topical corticosteroids where infection is present as this can cause the infection to worsen or spread. Where facial lesions are present, potent corticosteroids should be avoided and treatment courses should be short.

There are generally no significant drug interactions when corticosteroids are used topically. If several topical agents are being used on the same area of skin, applications should be spaced out to allow absorption of pharmacologically active agents; emollients should be applied last.

TeacherOfMedicine