Corticosteroids therapeutic applications

Figure 1.7. Structure of some of the major corticosteroids that have found routine therapeutic application...

The first example of the influence of a fluorine atom on the biological properties of a molecule was for a family of corticosteroids. This discovery has very important applications on a medicinal level the use of fluorinated compounds to modify biological properties for therapeutic applications. 

Shortly after the introduction of corticosteroids to ocular therapeutics, clinical use indicated that local treatment was equal to or superior to systemic administration, provided that the diseased tissue could be brought in contact with sufficient concentration of steroid. In general, when possible topical administration is indicated for anterior segment disease. Ease of application, comparatively low cost, and relative absence of systemic complications make it the preferred route of steroid therapy. Selection of a particular topical steroid and the dosage... 

The therapeutic effectiveness of topically applied corticosteroids is attributed primarily to their antiinflammatory activity. The relative efficacy of topical corticosteroids appears to be in the following order hydrocortisone, prednisolone, betamethasone < hydrocortisone valerate or butyrate, betamethasone valerate, triamcinolone acetonide, flucinolone acetonide < betamethasone dipropionate, fluocino-nide. In addition to the nature of the corticosteroid, its solubility, and, to a lesser extent, the concentration used, clinical efficacy is influenced by the formulation of the preparation. Glucocorticoids appear to have greater efficacy when formulated in ointment bases than in cream or lotion vehicles. This could be attributed to the occlusive effect provided by ointments. The application of an occlusive dressing further enhances penetration and persistence of the steroid (reservoir effect) in the stratum corneum. " ... 

Glucocorticoids have a very wide application as antiinflammatory agents in therapeutics. The route by which they are administered depends largely on their relative freedom from dangerous side-effects. Many are used by topical application, but some are intrinsically more powerful than others and may only be used when weaker corticosteroids have failed. Different salts may be used for certain purposes. 

If the vulva is significantly irritated, topical application of a low-potency corticosteroid may be beneficial. Anecdotal evidence suggests that high-potency corticosteroids may exacerbate the burning sensation initially. Table 118-2 lists the therapeutic options for the treatment of uncomplicated VVC. 

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