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topical glucocorticoid (topical steroid)

Agents applied to skin. Excludes nasal & inhaled glucocorticoids Classification: 1) class 1 (most potent)* a) clobetasol propionate 0.05% b) betamethasone dipropionate ointment 0.05% (Diprolene) c) halobetasol propionate 0.05% (Ultravate) d) diflorasone diacetate 0,05% (Psorcon) 2) class 2 a) augmented betamethasone diproprionate cream 0.05% (Diprosone) (in optimized vehicle) b) fluocinonide 0.05% c) desoximetasone 0.25% 3) class 3 (high potency) a) betamethasone dipropionate cream 0.05% b) betamethasone valerate ointment 0.1% c) triamcinolone acetonide ointment 0.1% d) triamcinolone acetonide cream 0.5% e) fluticasone propionate ointment 0.05% 4) class 4 a) triamcinolone acetonide cream 0.1% b) hydrocortisone valerate ointment 0.2% c) fluocinolone acetonide ointment 0.025% d) fluticasone propionate cream 0.05% 5) class 5 a) betamethasone valerate cream 0.1% b) hydrocortisone valerate cream 0.2% c) triamcinolone acetonide lotion 0.1% d) fluocinolone acetonide cream 0.025% 6) class 6 a) betamethasone valerate lotion 0.05% b) desonide cream 0.05% c) fluocinolone acetonide cream 0.01% d) fluocinolone acetonide solution 0.05% 7) class 7 (least potent)* - hydrocortisone 1-2.5% * classification from most to least potent Contraindications: - pregnancy category C but generally appear safe [4] - avoid use of potent topical glucocorticoids on the face, neck, intertriginous skin folds, groin & on atrophic skin [2] - avoid combined use of glucocorticoids with antifungal agents [2] Adverse effects: 1) common* - skin atrophy, thinning & wrinkling of skin - more likely to occur in intertriginous areas, the face, & popliteal fossa or antecubital fossa - striae, visible veins, telangiectasia - acne, rosacea - perioral dermatitis - easy bruising, purpura 2) less common - hypertrichosis - pigmentation alterations - delayed wound healing - exacerbation of skin infections 3) other - contact sensitization 4) systemic reactions with chronic use of potent agents [2,6] - hyperglycemia - systemic absorption may increase risk of type 2 diabetes [12] - glaucoma - cataracts [7,8] - adrenal insufficiency - high doses of potent glucocorticoid during pregnancy may result in low birth weight infant [4] - potent topical glucocorticoids associated with increased risk for osteoporosis & major fracture (< 122/10,000 patient years) [14] * adverse effects more common when applied to areas of occlusion by clothing or skin folds [2]; use least potent topical glucocorticoid when appled to these areas [7] Drug interactions: - avoid use of antifungal agents with topical glucocorticoids - can worsen some Tinea infections - high risk of striae when used in groin area Mechanism of action: - anti-inflammatory - inhibits collagen production Notes: - co-pay & wholesale price vary widely for topical glucocorticoids [9] - Medicare part D costs for topical glucocorticoids increased substantially from 2011-2015 [11] - there is a generic equivalent in each class of topical glucocorticoid [2]

Interactions

drug adverse effects of glucocorticoids monitor with drug (more general terms)

Specific

Alclometasone Topical (Aclovate, Acloson, Delonal) Amcinonide Topical antibiotic-glucocorticoid combination Betamethasone Topical (Betatrex, Diprolene, Diprosone, Luxig foam, Valisone) clocortolone topical (Cloderm) Cortisol Topical (Westcort, Locoid, Hytone, Lacticare HC, Pramosome) Desonide Topical (DesOwen, Tridesilon) Desoximetasone Topical Diflorasone Topical (Psorcon, Florone, Maxiflor) difluprednate (Durezol) Fluocinolone Topical (Synalar, Synemol, Fluonid, Derma-Smoothe/FS, Synandrone) Fluocinonide Topical (Lidex) Flurandrenolide Topical (Cordran) Fluticasone Topical (Cutivate) Halcinonide Topical (Halog) halobetasol topical (Ultravate) Mometasone Topical prednicarbate topical (Dermatop E) Triamcinolone Topical (Aristocort, Kenacort)

General

topical anti-inflammatory agent glucocorticoid

References

  1. Prescriber's Letter 16(12): 2009 Comparison of Topical Corticosteroids Detail-Document#: 251227 (subscription needed) http://www.prescribersletter.com
  2. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2022.
  3. Prescriber's Letter 18(10): 2011 Hyperglycemia Associated with Non-oral and Locally Injected Corticosteroids Detail-Document#: 271022 (subscription needed) http://www.prescribersletter.com
  4. Chi CC et al Pregnancy Outcomes After Maternal Exposure to Topical Corticosteroids. A UK Population-Based Cohort Study. JAMA Dermatol. Published online September 04, 2013 PMID: 24005903 http://archderm.jamanetwork.com/article.aspx?articleid=1735120
  5. Del Rosso J, Friedlander SF. Corticosteroids: options in the era of steroid-sparing therapy. J Am Acad Dermatol. 2005 Jul;53(1 Suppl 1):S50-8. PMID: 15968264
  6. Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006 Jan;54(1):1-15 PMID: 16384751
  7. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  8. Haeck IM, Rouwen TJ, Timmer-de Mik L Topical corticosteroids in atopic dermatitis and the risk of glaucoma and cataracts. J Am Acad Dermatol. 2011 Feb;64(2):275-81 PMID: 21122943
  9. Skojec A, Foulke G, Kirby JS. Variation in the Cost of Generic Topical Corticosteroids. JAMA Dermatol. 2015 Aug 19 PMID: 26288382
  10. Beer K, Downie J. Sequelae from inadvertent long-term use of potent topical steroids. J Drugs Dermatol. 2007 May;6(5):550-1 PMID: 17679193
  11. Song H, Adamson A, Mostaghimi A. Medicare Part D payments for topical steroids: Rising costs and potential savings. JAMA Dermatol 2017 Aug; 153:755. PMID: 28453645 http://jamanetwork.com/journals/jamadermatology/article-abstract/2623534
  12. Andersen YMF, Egeberg A, Ban L et al. Association between topical corticosteroid use and type 2 diabetes in two European population-based adult cohorts. Diabetes Care 2019 Jun; 42:1095 PMID: 30936111 http://care.diabetesjournals.org/content/42/6/1095
  13. Ference JD, Last AR Choosing topical corticosteroids. Am Fam Physician. 2009 Jan 15;79(2):135-40. PMID: 19178066 Free article.
  14. Egeberg A, Schwarz P, Harslof T et al Association of Potent and Very Potent Topical Corticosteroids and the Risk of Osteoporosis and Major Osteoporotic Fractures. JAMA Dermatol. Published online January 20, 2021. PMID: 33471030 https://jamanetwork.com/journals/jamadermatology/article-abstract/2775153 - Jackson RD Topical Corticosteroids and Glucocorticoid-Induced Osteoporosis - Cumulative Dose and Duration Matter. JAMA Dermatol. Published online January 20, 2021 PMID: 33471024 https://jamanetwork.com/journals/jamadermatology/article-abstract/2775150