13.4 Topical Corticosteroids

Topical corticosteroids are not recommended in urticaria, rosacea, acne or undiagnosed, possibly infective, disorders.

To minimise the risk of side-effects, the smallest effective amount should be used, reducing strength and frequency of application as the condition settles.  The risk of systemic side-effects increases with prolonged use on thin, inflamed or raw skin surfaces, use in flexures, or use of more potent corticosteroids.  Occlusion increases efficacy and side-effects.  Only mild corticosteroids should be used on the face.

Gloves should be worn during, or hands washed after, application of large quantities of steroid preparations.

The occlusive effect of ointments increases penetration of the corticosteroid.

Palms and soles may require potent or very potent steroids.

Loss of effect with time (tachyphylaxis) can occur with prolonged use.

Mild corticosteroid

1st     HYDROCORTISONE 1% ointment & cream 

Moderately potent corticosteroid

1st      BETAMETHASONE VALERATE 0.025% ointment & cream 
2nd     CLOBETASONE BUTYRATE 0.05% (Yellow) ointment & cream
        FLUOCINOLONE ACETONIDE 0.00625% cream & ointment

Potent corticosteroid

1st      BETAMETHASONE VALERATE 0.1% ointment & cream 
2nd     MOMETASONE ointment
        HYDROCORTISONE BUTYRATE cream & Lipocream

Very potent corticosteroid

1st      CLOBETASOL PROPIONATE 0.05% ointment & cream 
        FLUDROXYCORTIDE (Haelan tape) useful for hands and cracked skin on fingers 


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