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Topical Steroids

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ANTIINFLAMMATORY

ACTIONInhibition of

enzymephospholipase A2

by induction ofinhibitory proteins

IMMUNOSUPRESSIVE ACTIONinhibit

proinammatorygenes , inhibitsphagocytosis andstabilises lysosomalmembranes

VASOCONSTRICTION

ANTI PROLIFERATIVEACTION

on broblasts, inhibitsynthesis of both

mucopolysaccharidesand collagen

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Basic structure of

corticosteroid

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Classication :

Class 1 Superpotent

Class 2

Class 3

Class 4Class

Class ! M"l#

Class $ Least potent

ased on !asoconstrictor assay, the e"tent to #hichthe agent causes cutaneous !asoconstriction$%blanching e&ect'( in normal, healthy persons)

Potent

M"#stren%t&

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Some commonly used drugs :

Class 1'Superpotent(

)eta*et&asone #"prop"onateo"nt*ent+ ,rea*+ -.-/Clo0etasol prop"onate o"nt*ent+,rea*+ -.-/

alo0etasol prop"onate o"nt*ent+,rea*+ -.-/

Class 2 'Potent( eso"*etasone o"nt*ent+ ,rea*+-.2/%el -.-/

Class 3 'Potent( Tr"a*,"lonone a,eton"#e o"nt*ent+-.1/Tr"a*,"lonone a,eton"#e ,rea*+-./

Class 4 'M"#stren%t&( Fluo,"nolone a,eton"#e ,rea*+ -.2/

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Sensible topical drug therapy in!ol!es not only theselection of an appropriate agent, but also a

thoughtful consideration of the areas of the bodya&ected)

)as", pr"n,"ples

*) State of the diseased s+in

$athologic changes(

2) Area of the body

-) Concentration of the drug

.) Type of !ehicle $e)g),ointment, cream, lotion(

/) 0ethod of application1) A dened duration of usethat both ma"imizes

ecacy and minimizesad!erse side e&ects)

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Indications

3czematous disorders: Atopic dermatitis,contact dermatitis, seborrheic dermatitis,nummular dermatitis, lichen simple",

prurigo, house#i!es4s eczema, diaperdermatitis

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Indications

apulos5uamous disorders: soriasis,lichen planus, pityriasis rosea

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Indications Connecti!e tissue disorder: 6upus

erythematosus, dermatomyositis

7eutrophilic dermatoses: ehcet4sdisease, pyoderma gangrenosum

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Indications ullous dermatoses: emphigus foliaceus,

bullous pemphigoid, pemphigoidgestationis

8thers: acne +eloidalis nuchae, alopeciaareata, aphthous ulcer, !itiligo, lichensclerosus et atrophicus

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Contraindications: A0solute: prior

h9o hypersensiti!ity

to topicalcorticosteroid or acomponent of the!ehicle

Relat"6e:untreated localbacterial, fungal,

!iral orm cobacterial

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Na"ls0id strength to mildpotent $digital

atrophy(

Pal*s an# Solesotent ;Super potent

class

Fa,e an#ano%en"tal

6east potent; mildclass

Trun7 an#Etre*"t"es

0id strength; otentclass

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LESION RECOMMENE AVOIE

Acute erythema 6otion, cream 8intment, paste

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Side 3&ects of

Topical Steroids

>a!inder Singh Au?la>oll no) **@2@*@@

Serial B2.-

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Lo,al S"#e E8e,ts

8ccur #ith prolonged treatment

epend on:

The potency of the topicalcorticosteroid,

The !ehicle $ointments, creams orlotions(

The site of application

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Atrophy is the most common ad!ersee&ect

articularly seen on intertriginous areas

Striae tend to beirre!ersible

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A,ne"9or* Erupt"ons

Caused by degradation of follicularepithelium, resulting in e"trusion offollicular content)

>osacea

erioralermatitis

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Purpura ; rash of purplespots on the s+in due tointernal bleeding ofsmall blood !essels$8n use of strongsteroids, caused by

atrophy of the collagen

Telan%"e,tas"a;

dilatation of thecapillaries causingthem to appear assmall red or purple

clusters, often spidery

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Less Fre:uent Lo,al

S"#e E8e,ts Dypertrichosis $abnormal amount of hair

gro#th o!er the body(

igmentation alterations

elayed #ound healing

3"acerbation of s+in infections

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;"tra

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Top",al Stero"#

epen#ent Fa,e >ebound erythema, burning and scalingof the face on attempted stoppage of thesteroid)

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S5ste*", S"#e E8e,ts >are, but may occur #hen highly potent steroids

are used for prolonged periods of time on areas ofthin s+in li+e the face or inamed surfaces)

Suppression of hypothalamic;pituitary;adrenal

a"is Cushing4s syndrome

Dyperglycemia

Ero#th retardation in children $suppressi!e e&ect

on osteoblastogenesis in the bone marro# andpromote apoptosis of osteoblasts and osteocytes,thus leading to decreased bone formation(

Cataract formationor glaucoma$application toeyelids(