Topical Steroids

 

click on heading to sort

Application

1. Finger-Tip Unit (FTU)

• This method helps in measuring the amount of topical steroid to apply.
• Definition: One FTU is the amount of cream or ointment squeezed from a standard tube along the length of an adult’s fingertip (from the tip to the first joint).
• Application: Different body areas require different FTU amounts. For instance, an adult might need 2 FTUs for the face, 4 FTUs for an arm, and 8 FTUs for a leg.

2. Wet Wrap Therapy

• Commonly used for severe eczema or cases where deep penetration is needed.
• Method:
  • After applying the steroid cream, the area is wrapped in a layer of wet gauze or a wet towel.
  • This is then covered with a dry layer to seal in moisture.
  • The occlusion increases the absorption of the steroid and helps with hydration.
• Duration: Usually kept on for a specified time (often several hours), sometimes overnight, depending on the severity and location of the lesion.
• Benefits: Can provide rapid relief and reduce severe inflammation, but should be monitored to avoid skin thinning or infection.

3. Occlusive Dressings

• These involve applying a topical steroid and covering it with an impermeable dressing like plastic wrap.
• Method:
  • Apply the steroid to the affected area and then cover it with a plastic wrap, ensuring it’s sealed well.
  • This traps moisture and increases skin permeability, enhancing the medication’s absorption.
• Use: Generally used in short bursts and under medical supervision to prevent adverse effects, especially in delicate areas.

4. Soaking Techniques

• This stands for Continuous Topical Veiling, a method where a wet towel is used to help in the application.
• Method:
  • The area is soaked with a wet towel after applying the steroid, which increases moisture and absorption.
  • Typically, this is less occlusive than full wet wraps and can be useful in milder cases.
• Benefit: Provides moisture without full occlusion, helping prevent overly intensive absorption that may cause skin thinning.

5. Pulse Therapy

• Used in conditions needing intermittent, high-potency steroid application.
• Method: The steroid is applied for a short period (e.g., twice daily for 2-3 days), followed by a break.
• Benefit: Minimizes the risk of side effects by reducing continuous exposure.

6. Application Timing and Frequency

• Steroids should generally be applied once or twice daily, as advised, as more frequent applications do not necessarily improve effectiveness and can increase side effects.
• Timing should follow a consistent schedule, ideally after a bath or shower, when the skin is more absorbent.

Key Points for Safe Steroid Use:

• Duration and Potency: Low-potency steroids are generally used for sensitive areas (like the face), while higher-potency steroids can be used on thicker skin, like the palms and soles.
• Monitoring: Prolonged use should always be monitored to avoid side effects like skin thinning, telangiectasia, or systemic absorption.

 

Safety Information

Contraindications:

• Hypersensitivity: Contraindicated in individuals with known hypersensitivity to any of the components.
• Viral Skin Infections: Generally contraindicated in viral infections, including:
  • Vaccinia (smallpox)
  • Varicella (chickenpox)
  • Herpes simplex
• Other Conditions: Tuberculosis, acne rosacea.

Precautions:

1. Irritation or Sensitization: Discontinue if significant irritation or hypersensitivity occurs.
2. Presence of Infection:
   • Topical corticosteroids may aggravate untreated bacterial or fungal infections.
   • Consider co-administering an appropriate antifungal or antibacterial agent if infection is present.
   • If infection persists, discontinue corticosteroid use until infection is controlled.
3. Prolonged and Extensive Treatment:
   • Limit continuous treatment duration to 4 weeks as a general guideline.
4. Systemic Effects: Potential for systemic absorption, particularly with high-potency corticosteroids or in large-area applications. Possible effects include:
   • Adrenal suppression: Potentially low plasma cortisol, lack of response to ACTH stimulation.
   • Growth and Weight Concerns: Linear growth retardation and delayed weight gain in children.
   • Intracranial Hypertension: Especially in children, may manifest as bulging fontanelles, headaches, and bilateral papilledema.
   • Cushing’s Syndrome Manifestations
5. Skin and Subcutaneous Effects: Striae or atrophy in prolonged use.
6. Eye Precaution: Avoid use near the eyes to prevent complications like glaucoma or cataracts.
   • Visual disturbances may occur with both topical and systemic corticosteroid use.

DIPROSONE OV

• Contraindications:  as above
• Precautions:  as above  +
  • Patients should not use more than 45 g DIPROSONE OV weekly
  • suppress the hypothalamic-pituitary adrenal (HPA) axis
    • with repeated application of 7 g/day.
    • application of 14 g per day of DIPROSONE OV Cream for 8 days produced a depression of adrenocortical hormonal levels in plasma, including plasma cortisol levels. Shortly after treatment cessation, adrenal output returned to normal.
  • not intended for use under occlusive dressings
  • not recommended for use in children under 12 years of age
• Adverse Events:  as above