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Topical Corticosteroids

Topical Corticosteroids Potency Selector

topical steroids
Corticosteroid strength has been classified according to the vasoconstrictor assay, which is based on the extent to which the compound induces cutaneous vasoconstriction ("blanching effect") in normal human subjects
Product Potency:

* Relative potency of a product depends on the characteristics and concentration of the drug and the vehicle.
* Generally, ointments and gels are more potent than creams or lotions; however, some products have been formulated to yield comparable potency.

Product Selection:

* Selection of a specific corticosteroid, strength, and vehicle depends on the nature, location, and extent of the skin condition, patient’s age, and anticipated duration of treatment.
* Use the least potent corticosteroid that would be effective.
* Low potency agents are preferred for the face, intertriginous areas (e.g., groin, axilla), large areas, and children, to reduce the potential for side effects.
* Reserve higher potency agents for areas and conditions resistant to treatment with milder agents.

Adverse Reactions:

* Systemic absorption of topical corticosteroids has produced reversible HPA axis suppression, Cushing’s syndrome, hyperglycemia, and glycosuria.
* Conditions that augment systemic absorption include application of more potent steroids, use over large surface areas, prolonged use, addition of occlusive dressings, and patient’s age.
* Perform appropriate clinical and laboratory tests if a topical corticosteroid is used for long periods or over large areas of the body.

With chronic conditions, gradual discontinuation of therapy may reduce the chance of rebound.
References
1] Habif TP. Clinical Dermatology. 4th ed. St. Louis, Mo: Mosby, Inc. 2004.

2] Hengge et al. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006 Jan;54(1):1-15.

3] Jacob SE, Steele T. Corticosteroid classes: a quick reference guide including patch test substances and cross-reactivity. J Am Acad Dermatol. 2006 Apr;54(4):723-7.

4] Klaus Wolff, Lowell A. Goldsmith, Stephen I. Katz, Barbara A. Gilchrest et al. Editors, Fitzpatrick’s Dermatology in General Medicine, 7th Edition, New York: McGraw-Hill; 2007.

5] Ong PY, Boguniewicz M. Atopic Dermatitis. Prim Care Clin Office Pract. 2008 Mar;35(1):105–117.

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