« Back to Treatment of Skin Disorders

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.

When are combination topical steroid and antiinfective products indicated?

The combination products are often marginally effective and expensive. The most commonly prescribed products are Mycolog II (nystatin/triamcinolone) and Lotrisone (clotrimazole/betamethasone). Lotrisone is approved by the U.S. Food and Drug Administration (FDA) for tinea cruris/corporis/pedis in adults and children more than 12 years of age.

Few nondermatology physicians recognize the steroid component to be fluorinated and high-/midpotency. They are also more likely to prescribe this product to children less than 5 years of age for use on genital skin. A baby’s diaper is occlusive, enhancing absorption, as well as the likelihood of side effects. Use of these products may lead to persistent and recurrent disease.

Alston SJ, Cohen BA, Braun M: Persistent and recurrent tinea corporis in children treated with combination antifungal/ corticosteroid agents, Pediatrics 111(1):201–203, 2003.

Railan D, Wilson JK, Feldman SR, Fleischer AB: Pediatricians who prescribe clotrimazole-betamethasone diproprionate (Lotrisone) often utilize it in inappropriate settings regardless of their knowledge of the drug’s potency, Dermatol Online J 8(2):3, 2002.

Shaffer MP, Feldman SR, Fleischer AB Jr: Use of clotrimazole/ betamethasone diproprionate by family physicians, Fam Med 32(8):561–565, 2000.