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Topical Steroids

»	When were corticosteroids discovered? When were they first used therapeutically?
»	Describe the basic steroid nucleus.
»	How is the potency of topical steroid medications determined?
»	How do topical steroids inhibit cutaneous inflammation?
»	How are topical corticosteroids classified as to potency?
»	How many topical steroid medications are available in the United States?
»	What are the differences between brand name and generic topical steroid products?
»	With so many products available, how do you decide which product to prescribe for your patient?
»	What specific directions should be provided when prescribing super-, high-, and midpotency topical steroids?
»	Why is the vehicle important when recommending a topical corticosteroid?
»	Are certain vehicles preferred for particular types of lesions or anatomic sites?
»	A patient has 5% total body surface area (TBSA) involvement. How much topical steroid should be prescribed for twice daily application for a 1-week-on and 1-week-off treatment cycle? The patient will return in 4 weeks for follow-up.
»	How should the FTU application technique be applied to children?
»	When are combination topical steroid and antiinfective products indicated?
»	What is tachyphylaxis and how can it be prevented?
»	What are the local cutaneous side effects of topical steroids?
»	What are the effects of topical steroids on the epidermis?
»	What are the effects of topical steroids on the dermis?
»	What are the systemic side effects of topical steroid therapy?
»	Are there topical steroid addicts?
»	What is periorificial dermatitis?
»	What is tinea incognito?
»	Can topical steroid medications cause contact dermatitis?
»	Mrs. Jones brings her 9-month-old infant with moderate atopic dermatitis to your office. What topical steroid do you prescribe?
»	A 40-year-old woman presents with a 5-year history of chronic dermatitis on her palms. Lesions are plaques with abundant scale. What topical steroid do you prescribe?
»	A 35-year-old woman with moderate psoriasis presents with scalp, facial, and body plaque lesions. What topical steroid do you prescribe?
»	Mrs. Smith brings her 6-month-old infant with a 2-week history of diaper dermatitis to your office. What topical steroid do you prescribe? Would you recommend any other topical therapy?
»	List some common mistakes that are made when prescribing a topical steroid.

A patient has 5% total body surface area (TBSA) involvement. How much topical steroid should be prescribed for twice daily application for a 1-week-on and 1-week-off treatment cycle? The patient will return in 4 weeks for follow-up.

Fig. 50.2 Demonstration of a fingertip unit (FTU), which is approximately 0.5 grams of medication. (Courtesy of the John L. Aeling, M.D. Collection.)

Topical medications are frequently under- or overprescribed, and only a thin layer of medication is necessary. Use the fingertip unit (FTU) application technique and percent of TBSA to calculate the amount needed: 1 FTU equals approximately 0.5 gm of medication and will treat 2% TBSA in the average adult. The patient will need approximately 35 grams for the next 4 weeks. Calculation: (5% TBSA/1 application) × (1 FTU/2% TBSA) × (0.5 grams/1 FTU) × 14 day × (2 applications/1 day) = 35 grams.

NOTE: One FTU is the amount of medication expressed from a tube with a 5-mm opening that extends from the distal interphalangeal crease to the tip of the finger (Fig. 50-2). One palm size, including fingers, represents 1% TBSA.