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 — General 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
●MedicationTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- 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
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS