Topical steroids

Topical steroids provide effective anti-inflammatory treatment but have the disadvantage of causing atrophy (due to decreased fibrin formation) and telangiectasis. They are readily absorbed by thin skin around the eyes and in flexures. On the face the halogenated steroids produce considerable telangiectasia, so nothing stronger than hydrocortisone should be used (except in lupus erythematosus). They can cause hirsutism and folliculitis or acne. Infection of the skin may be concealed (tinea incognita, for example) or made worse.

Side effects can be avoided by observing the following guidelines:

• Avoid long term use of strong steroids.

• Potent or very potent steroids should be applied sparingly and often for a short time, then a less potent preparation less often as the condition improves.

• Use only mildly potent steroids (that is, hydrocortisone) on the face.

• Use preparations combined with antibiotics or antifungals for the flexures.

Topical steroids come in various strengths and a wide variety of bases—ointments, creams, oily creams, lotions, and gels—which can be used according to the type of lesion being treated.

Grease Paste

Grease Paste

Water Lotion/ Powder suspension

Their pharmacological activity varies and they are classified according to their potency, the synthetic halogenated steroids being much stronger than hydrocortisone:

• Mildly potent—hydrocortisone 0-5%, 1%, and 2-5%

• Moderately potent—Eumovate (GSK), Stiedex LP (Stiefel)

• Potent—Betnovate (GSK), Cutivate (GSK), Locoid (Brocades), Synalar (Zeneca)

In Britain a full list showing relative potencies appears in MIMS. Combinations with antiseptics and antifungals, are listed below:

Mildly potent

• Terra-Cortril ointment (Pfizer), containing oxytetracycline and hydrocortisone

• Fucidin H cream or ointment (Leo), containing fucidic acid and hydrocortisone

• Daktacort cream (Janssen)

Moderately potent

• Betnovate N (betamethasone and neomycin) (GSK)

• Trimovate cream (clobetasone butyrate, nystatin, and oxytetracyclin; GSK)

• Fucibet (betamethasone, fucidic acid; Leo)

Very potent

• Dermovate-NN (clobetasone, with neomycin and nystatin; GSK).

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