Topical Steroids

VASOCONSTRIC
TION

ANTI
INFLAMMATORY
ACTION
Inhibition of
enzyme
phospholipase A2
by induction of
inhibitory proteins

ANTI PROLIFERATIVE
ACTION
on fibroblasts, inhibit
synthesis of both
mucopolysaccharides
and collagen

IMMUNOSUPRESS
IVE ACTION
inhibit
proinflammatory
genes , inhibits
phagocytosis and
stabilises lysosomal
membranes

Basic structure of
corticosteroid

Classification :
Based on vasoconstrictor assay, the extent to which
the agent causes cutaneous vasoconstriction
(blanching effect) in normal, healthy persons.
Class
Class
Class
Class
Class
Class
Class

1
2
3
4
5
6
7

Superpotent
Potent
Midstren
gth
Mild
Least potent

Some commonly used drugs :

Class 1
(Superpotent)

Betamethasone dipropionate
ointment, cream, 0.05%
Clobetasol propionate ointment,
cream, 0.05%
Halobetasol propionate ointment,
cream, 0.05%
Class 2 (Potent) Desoximetasone ointment, cream,
0.25%;
gel 0.05%
Class 3 (Potent) Triamcilonone acetonide ointment,
0.1%
Triamcilonone acetonide cream,
0.5%
Class 4 (Mid
Fluocinolone acetonide cream, 0.2%
strength)

Sensible topical drug therapy involves not only the

selection of an appropriate agent, but also a
thoughtful consideration of the areas of the body
affected.
Basic principles
1. State of the diseased skin
(Pathologic changes)
2. Area of the body
3. Concentration of the drug
4. Type of vehicle (e.g.,
ointment, cream, lotion)
5. Method of application
6. A defined duration of use
that both maximizes
efficacy and minimizes
adverse side effects.

Indications
Eczematous disorders: Atopic dermatitis,
contact dermatitis, seborrheic dermatitis,
nummular dermatitis, lichen simplex,
prurigo, housewivess eczema, diaper
dermatitis

Indications
Papulosquamous disorders: Psoriasis,
lichen planus, pityriasis rosea

Indications
Connective tissue disorder: Lupus
erythematosus, dermatomyositis
Neutrophilic dermatoses: Behcets
disease, pyoderma gangrenosum

Indications
Bullous dermatoses: Pemphigus foliaceus,
bullous pemphigoid, pemphigoid
gestationis
Others: acne keloidalis nuchae, alopecia
areata, aphthous ulcer, vitiligo, lichen
sclerosus et atrophicus

Contraindications:
Absolute: prior
h/o hypersensitivity
to topical
corticosteroid or a
component of the
vehicle
Relative:
untreated local
bacterial, fungal,
viral or
mycobacterial

Palms and Soles

Potent -Super potent
class

Trunk and
Extremities
Mid strength- Potent
class

Face and
anogenital
Least potent- mild
class

Nails
Mid strength to mild
potent (digital
atrophy)

LESION

RECOMMENDED

AVOIDED

Acute erythema

Lotion, cream

Ointment, paste

Vesicles

Lotion, gel

Paste, ointment

Blisters

Wet dressings,
lotion

Paste, ointment,
powder

Erosions

Wet dressings,
ointment

Powder, lotion

Crusts

Ointment, wet
dressing

Powder, gel

Chronic
inflammation

Ointment

Side Effects of
Topical Steroids
Ravinder Singh Aujla
Roll no. 110201009
Serial #243

Local Side Effects

Occur with prolonged treatment
Depend on:
The potency of the topical
corticosteroid,
The vehicle (ointments, creams or
lotions)
The site of application

 Atrophy is the most common adverse

effect
Particularly seen on intertriginous areas
Striae tend to be
irreversible

Acneiform Eruptions
Caused by degradation of follicular
epithelium, resulting in extrusion of
follicular content.

Rosace
a

Perioral
Dermatitis

Purpura - rash of purple

spots on the skin due to
internal bleeding of
small blood vessels
(On use of strong
steroids, caused by
atrophy of the collagen

Telangiectasia dilatation of the

capillaries causing
them to appear as
small red or purple
clusters, often spidery

Less Frequent Local

Side Effects
Hypertrichosis (abnormal amount of hair
growth over the body)
Pigmentation alterations
Delayed wound healing
Exacerbation of skin infections

Withdrawal Side Effects

Corticosteroid addiction is generally seen on
the face.
Rebound flares of itching, redness,
pustulation and scaling may be seen.
Sometimes red burning skin syndrome.

Topical Steroid
Dependent Face

Rebound erythema, burning and scaling

of the face on attempted stoppage of the
steroid.

Systemic Side Effects

Rare, but may occur when highly potent steroids
are used for prolonged periods of time on areas of
thin skin like the face or inflamed surfaces.
Suppression of hypothalamic-pituitary-adrenal
axis
Cushings syndrome
Hyperglycemia
Growth retardation in children (suppressive effect
on osteoblastogenesis in the bone marrow and
promote apoptosis of osteoblasts and osteocytes,
thus leading to decreased bone formation)
Cataract formation or glaucoma (application to
eyelids)