General principles of dermatologic therapy and topical corticosteroid use
- Beth G Goldstein, MD
Beth G Goldstein, MD
- Adjunct Clinical Assistant Professor
- Department of Dermatology
- University of North Carolina at Chapel Hill
- Adam O Goldstein, MD, MPH
Adam O Goldstein, MD, MPH
- Department of Family Medicine
- University of North Carolina at Chapel Hill
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — Dermatology
- Professor of Dermatology and Public Health
- University of Colorado School of Medicine
- Colorado School of Public Health
- Chief, Dermatology Service
- US Department of Veterans Affairs
- Eastern Colorado Health Care System
- Moise L Levy, MD
Moise L Levy, MD
- Section Editor — Pediatric Dermatology
- Professor of Pediatrics and Medicine (Dermatology)
- Dell Medical School, University of Texas, Austin
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
The success of dermatologic therapies is dependent upon many factors. General issues related to topical therapies will be reviewed here with a particular emphasis upon the use of topical corticosteroids.
There are five components to the successful use of topical therapies:
●Type of lesion being treated
- Miller JA, Munro DD. Topical corticosteroids: clinical pharmacology and therapeutic use. Drugs 1980; 19:119.
- Chan HL. The effects of topical corticosteroids on human skin. Ann Acad Med Singapore 1991; 20:133.
- Cornell RC, Stoughton RB. Correlation of the vasoconstriction assay and clinical activity in psoriasis. Arch Dermatol 1985; 121:63.
- Feiwel M, James VH, Barnett ES. Effect of potent topical steroids on plasma-cortisol levels of infants and children with eczema. Lancet 1969; 1:485.
- McKensie AW, Stoughton RB. Method for comparing cutaneous absorption of steroids. Arch Dermatol 1962; 86:608.
- Stoughton RB, Wullich K. The same glucocorticoid in brand-name products. Does increasing the concentration result in greater topical biologic activity? Arch Dermatol 1989; 125:1509.
- Olsen EA. A double-blind controlled comparison of generic and trade-name topical steroids using the vasoconstriction assay. Arch Dermatol 1991; 127:197.
- Drake LA, Dinehart SM, Farmer ER, et al. Guidelines of care for the use of topical glucocorticosteroids. American Academy of Dermatology. J Am Acad Dermatol 1996; 35:615.
- Hanifin J, Gupta AK, Rajagopalan R. Intermittent dosing of fluticasone propionate cream for reducing the risk of relapse in atopic dermatitis patients. Br J Dermatol 2002; 147:528.
- Glazenburg EJ, Wolkerstorfer A, Gerretsen AL, et al. Efficacy and safety of fluticasone propionate 0.005% ointment in the long-term maintenance treatment of children with atopic dermatitis: differences between boys and girls? Pediatr Allergy Immunol 2009; 20:59.
- Hebert AA, Friedlander SF, Allen DB. Topical fluticasone propionate lotion does not cause HPA axis suppression. J Pediatr 2006; 149:378.
- Resnick SD, Hornung R, Konrad TR. A comparison of dermatologists and generalists. Management of childhood atopic dermatitis. Arch Dermatol 1996; 132:1047.
- Balkrishnan R, Camacho FT, Pearce DJ, et al. Factors affecting prescription of ultra-high potency topical corticosteroids in skin disease: an analysis of US national practice data. J Drugs Dermatol 2005; 4:699.
- Ozon A, Cetinkaya S, Alikasifoglu A, et al. Inappropriate use of potent topical glucocorticoids in infants. J Pediatr Endocrinol Metab 2007; 20:219.
- Semiz S, Balci YI, Ergin S, et al. Two cases of Cushing's syndrome due to overuse of topical steroid in the diaper area. Pediatr Dermatol 2008; 25:544.
- Schlessinger J, Miller B, Gilbert RD, et al. An open-label adrenal suppression study of 0.1% fluocinonide cream in pediatric patients with atopic dermatitis. Arch Dermatol 2006; 142:1568.
- Nelson AA, Miller AD, Fleischer AB, et al. How much of a topical agent should be prescribed for children of different sizes? J Dermatolog Treat 2006; 17:224.
- Chi CC, Wang SH, Kirtschig G, Wojnarowska F. Systematic review of the safety of topical corticosteroids in pregnancy. J Am Acad Dermatol 2010; 62:694.
- Edwards MJ, Agho K, Attia J, et al. Case-control study of cleft lip or palate after maternal use of topical corticosteroids during pregnancy. Am J Med Genet A 2003; 120A:459.
- Mahé A, Perret JL, Ly F, et al. The cosmetic use of skin-lightening products during pregnancy in Dakar, Senegal: a common and potentially hazardous practice. Trans R Soc Trop Med Hyg 2007; 101:183.
- Hviid A, Mølgaard-Nielsen D. Corticosteroid use during pregnancy and risk of orofacial clefts. CMAJ 2011; 183:796.
- Chi CC, Mayon-White RT, Wojnarowska FT. Safety of topical corticosteroids in pregnancy: a population-based cohort study. J Invest Dermatol 2011; 131:884.
- Chi CC, Wang SH, Mayon-White R, Wojnarowska F. Pregnancy outcomes after maternal exposure to topical corticosteroids: a UK population-based cohort study. JAMA Dermatol 2013; 149:1274.
- Chi CC, Kirtschig G, Aberer W, et al. Evidence-based (S3) guideline on topical corticosteroids in pregnancy. Br J Dermatol 2011; 165:943.
- Katz HI, Prawer SE, Mooney JJ, Samson CR. Preatrophy: covert sign of thinned skin. J Am Acad Dermatol 1989; 20:731.
- Lebwohl MG, Tan MH, Meador SL, Singer G. Limited application of fluticasone propionate ointment, 0.005% in patients with psoriasis of the face and intertriginous areas. J Am Acad Dermatol 2001; 44:77.
- Litt JZ. Steroid-induced rosacea. Am Fam Physician 1993; 48:67.
- Hajar T, Leshem YA, Hanifin JM, et al. A systematic review of topical corticosteroid withdrawal ("steroid addiction") in patients with atopic dermatitis and other dermatoses. J Am Acad Dermatol 2015; 72:541.
- Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol 2006; 54:1.
- Davis MD, el-Azhary RA, Farmer SA. Results of patch testing to a corticosteroid series: a retrospective review of 1188 patients during 6 years at Mayo Clinic. J Am Acad Dermatol 2007; 56:921.
- Guin JD. Contact sensitivity to topical corticosteroids. J Am Acad Dermatol 1984; 10:773.
- Tadicherla S, Ross K, Shenefelt PD, Fenske NA. Topical corticosteroids in dermatology. J Drugs Dermatol 2009; 8:1093.
- Coopman S, Degreef H, Dooms-Goossens A. Identification of cross-reaction patterns in allergic contact dermatitis from topical corticosteroids. Br J Dermatol 1989; 121:27.
- Walsh P, Aeling JL, Huff L, Weston WL. Hypothalamus-pituitary-adrenal axis suppression by superpotent topical steroids. J Am Acad Dermatol 1993; 29:501.
- Keipert JA, Kelly R. Temporary Cushing's syndrome from percutaneous absorption of betamethasone 17-valerate. Med J Aust 1971; 1:542.
- Katz HI, Hien NT, Prawer SE, et al. Superpotent topical steroid treatment of psoriasis vulgaris--clinical efficacy and adrenal function. J Am Acad Dermatol 1987; 16:804.
- BECKER B. CATARACTS AND TOPICAL CORTICOSTEROIDS. Am J Ophthalmol 1964; 58:872.
- du Vivier A, Stoughton RB. Tachyphylaxis to the action of topically applied corticosteroids. Arch Dermatol 1975; 111:581.
- du Vivier A. Tachyphylaxis to topically applied steroids. Arch Dermatol 1976; 112:1245.
- Singh G, Singh PK. Tachyphylaxis to topical steroid measured by histamine-induced wheal suppression. Int J Dermatol 1986; 25:324.
- Miller JJ, Roling D, Margolis D, Guzzo C. Failure to demonstrate therapeutic tachyphylaxis to topically applied steroids in patients with psoriasis. J Am Acad Dermatol 1999; 41:546.
- Feldman SR. Tachyphylaxis to topical corticosteroids: the more you use them, the less they work? Clin Dermatol 2006; 24:229.
- Long CC, Finlay AY. The finger-tip unit--a new practical measure. Clin Exp Dermatol 1991; 16:444.
- Wilson R, Camacho F, Clark AR, et al. Adherence to topical hydrocortisone 17-butyrate 0.1% in different vehicles in adults with atopic dermatitis. J Am Acad Dermatol 2009; 60:166.
- Smith ES, Fleischer AB Jr, Feldman SR. Nondermatologists are more likely than dermatologists to prescribe antifungal/corticosteroid products: an analysis of office visits for cutaneous fungal infections, 1990-1994. J Am Acad Dermatol 1998; 39:43.
- Barkey WF. Striae and persistent tinea corporis related to prolonged use of betamethasone dipropionate 0.05% cream/clotrimazole 1% cream (Lotrisone cream). J Am Acad Dermatol 1987; 17:518.
- Reynolds RD, Boiko S, Lucky AW. Exacerbation of tinea corporis during treatment with 1% clotrimazole/0.05% betamethasone diproprionate (Lotrisone). Am J Dis Child 1991; 145:1224.
- GENERAL PRINCIPLES
- VEHICLE SELECTION
- Wet dressings
- TOPICAL CORTICOSTEROIDS
- Corticosteroid selection
- Treatment duration
- Use in children
- Use during pregnancy or lactation
- Side effects
- - Cutaneous
- - Systemic
- - Other
- INTRALESIONAL CORTICOSTEROID
- PITFALLS OF TREATMENT
- Suboptimal medication use
- Patient compliance
- Combination antifungal/topical corticosteroid products
- SUMMARY AND RECOMMENDATIONS