Topical preparations corticosteroids

Topical application of corticosteroids may lead to spreading of local skin infections, striae and thinning of the skin. Topical preparations containing corticosteroids should not normally be applied for more than 7 days. 

Topical preparations usually contain relatively insoluble steroids, such as clobetasol propionate, triamcinolone acetonide, or triamcinolone diacetate. Side effects of this mode of drug application are usually milder and more transient than those seen after systemically administered steroids. However, potent topical corticosteroids, such as clobetasol propionate (Temovate), can suppress adrenal function when used in large amounts for a long time, especially when the skin surface is denuded or when occlusive dressings are employed. Since the high potency topical preparations carry a higher risk of local side effects, their use should be held in reserve. 

Propylene Carbonate (PC) PC is prepared by reacting propylene chlorohydrin with sodium bicarbonate. It is available as a clear liquid with a faint odor. Mixtures of PC and propylene glycol are good solvents for corticosteroids in topical preparations. It is incompatible with strong acids, bases, and amines. The pH of 10% aqueous dispersion is 6.0-7.5 [34],... 

In topical applications, propylene carbonate has been used in combination with propylene glycol as a solvent for corticosteroids. The corticosteroid is dissolved in the solvent mixture to vield microdroplets that can then be dispersed in petrolatum. Propylene carbonate has been used as a dispensing solvent in topical preparations. ... 

Audicort Aureocort Aristocort Kenalog Ledercort ) is a corticosteroid, a glucocorticoid with ANTIINFLAMMATORY and ANTIALLERGIC properties. It is most commonly used in the form of the acetonide, to suppress the symptoms of inflammation, especially when it is caused by allergic disorders. It is sometimes used systemically to relieve conditions such as hay fever and asthma. It is commonly given by local injection to treat skin inflammation due to rheumatoid arthritis and hursitis. There are a number of topical preparations to treat severe, non-infective skin inflammation, such as eczema, or for treating inflammation in the mouth and ears. 

Neomycin currently is available in many brands of creams, ointments, and other products alone and in combination with polymyxin, bacitracin, other antibiotics and a variety of corticosteroids. There is no evidence that these topical preparations shorten the time required for healing of wounds or that those containing a steroid are more effective. 

Synonyms i6,i7-butylidenebis(oxy)-ii,2i-dihydroxypregna-i,4-diene-3,20-dione (R,S)-iib,i6a,i7,2i,tetrahydroxypregna-i,4-diene-3,20-dione cyclic 16,17-acetal with butyraldehyde S-1320 budeson Preferid Pulmicort Rhinocort Spirocort budenoside Uses non-halogenated corticosteroid for use in topical preparations and for the treatment of rhinitis and asthma good marker of corticosteroid allergy Cross hydrocortisone butyrate A... 

In 1973 D-homo corticosteroids (109—112), eg, D-homo-9a- uoroprednisolone acetate (111) were reported to have antiinflammatory activity (107). Compounds such as 21-acetoxy-liP- uoto-9a-chloto-17aa-hydtoxy-D-homo-ptegn-4-en-3,20-dione (110) had especially strong topical activity with weak systemic activity (108). Other preparations of D-homocorticoids included... 

There are hundreds of topical steroid preparations that are available for the treatment of skin diseases. In addition to their aforementioned antiinflammatory effects, topical steroids also exert their effects by vasoconstriction of the capillaries in the superficial dermis and by reduction of cellular mitosis and cell proliferation especially in the basal cell layer of the skin. In addition to the aforementioned systemic side effects, topical steroids can have adverse local effects. Chronic treatment with topical corticosteroids may increase the risk of bacterial and fungal infections. A combination steroid and antibacterial agent can be used to combat this problem. Additional local side effects that can be caused by extended use of topical steroids are epidermal atrophy, acne, glaucoma and cataracts (thus the weakest concentrations should be used in and around the eyes), pigmentation problems, hypertrichosis, allergic contact dermatitis, perioral dermatitis, and granuloma gluteale infantum (251). 

Topical therapy is the initial drug treatment strategy for patients with mild to moderate psoriasis. It is estimated that approximately 70% to 80% of all patients with psoriasis can he treated adequately with use of topical therapy.1 Topical therapies include corticosteroids, coal tar products, anthralin, vitamin D3 analogues such as calcipotriol, retinoids such as tazarotene, and topical immunomodulators such as tacrolimus and pime-crolimus.18 Vitamin D3 analogues and topical retinoids all affect keratinocyte functions and the immune response. Currently, these are in wider use than is either anthralin or coal tar preparations. 

Keratolytic agents such as salicylic acid are often added to bath oil or shampoos (typically 3% to 4%) for scalp psoriasis.10 Salicylic acid can also be added to topical corticosteroid preparations to enhance steroid penetration (salicylic acid breaks down keratin). 

Erythema, inflammation, pain, and itching caused by contact dermatitis can be effectively treated with topically applied corticosteroids. With such a wide range of products and potencies available, an appropriate steroid selection is based on severity and location of the lesions. Table 62-6 shows a list of topical steroids and their potencies. Higher-potency preparations are used in areas where penetration is poor, such as on the elbows and knees. Lower-potency products should be reserved for areas of higher penetration, such as on the face, axillae, and groin. Low-potency steroids are also recommended for the treatment of infants and children.32,33... 

Rhinocort Aqua and Nasonex are preparations containing topical nasal corticosteroids (budesonide and mometasone furoate respectively). Otrivine contains a nasal decongestant (xylometazoline) and Sudafed is a systemic preparation containing a nasal decongestant (phenylephrine). Molcer is a preparation for ear-wax removal and which contains docusate sodium. Emadine contains an antihistamine (emedastine) and is presented as eye drops. 

Rhinocort Aqua is the proprietary preparation of a topical nasal spray containing the corticosteroid budesonide and is marketed by AstraZeneca. 

Docusate sodium is a preparation used for softening ear wax before removal. Hydrocortisone is a corticosteroid, whereas gentamicin, neomycin and clioquinol are antibacterial agents. Otitis externa may be managed by the use of antibacterial preparations used alone or in combination with topical corticosteroids. 

Proprietary preparations of hydrocortisone for skin administration present a low-potency corticosteroid for topical skin administration. 

Topical antibacterial agents are used to prevent infection and in the early treatment of infected dermatoses and wounds. Various preparations contain corticosteroids in addition to antibacterial agents. 

Some topical anti-infectives contain corticosteroids in addition to antibiotics. There is no convincing evidence that topical corticosteroids inhibit the antibacterial effect of antibiotics when the two are incorporated in the same preparation. In the treatment of secondarily infected dermatoses, which are usually colonized with streptococci, staphylococci, or both, combination therapy may prove superior to corticosteroid therapy alone. Antibiotic-corticosteroid combinations may be useful in treating diaper dermatitis, otitis externa, and impetiginized eczema. 

Table 61-1 groups topical corticosteroid formulations according to approximate relative efficacy. Table 61-2 lists major dermatologic diseases in order of their responsiveness to these drugs. In the first group of diseases, low- to medium-efficacy corticosteroid preparations often produce clinical remission. In the second group, it is often necessary to use high-efficacy preparations, occlusion therapy, or both. Once a remission has been achieved, every effort should be made to maintain the improvement with a low-efficacy corticosteroid. 

Tar preparations are used mainly in the treatment of psoriasis, dermatitis, and lichen simplex chronicus. The phenolic constituents endow these compounds with antipruritic properties, making them particularly valuable in the treatment of chronic lichenified dermatitis. Acute dermatitis with vesiculation and oozing may be irritated by even weak tar preparations, which should be avoided. However, in the subacute and chronic stages of dermatitis and psoriasis, these preparations are quite useful and offer an alternative to the use of topical corticosteroids. 

Intralesional injection of steroid can lead to adrenal suppression. Infents and small children are especially susceptible, because a given amoimt of steroid is distributed in a smaller volume of fluid and tissue compartments. Infents injected with mixtiu es of triamcinolone acetonide and betamethasone or dexamethasone fiar periocular hemangiomas exhibited depressed serum cortisol and adrenocorticotropic hormone levels. The adrenal suppression can last up to 5 months and can result in weight loss and growth retardation. It is not known whether other corticosteroid preparations would produce similar effects or which other fectors might influence these results. In general, topical and periocular use of steroids produces minimal systemic effects. Withdrawal of topical or periocular steroids does not generally cause adrenal crisis. 

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