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Topical Steroids

»	When were corticosteroids discovered? When were they first used therapeutically?
»	Describe the basic steroid nucleus.
»	How is the potency of topical steroid medications determined?
»	How do topical steroids inhibit cutaneous inflammation?
»	How are topical corticosteroids classified as to potency?
»	How many topical steroid medications are available in the United States?
»	What are the differences between brand name and generic topical steroid products?
»	With so many products available, how do you decide which product to prescribe for your patient?
»	What specific directions should be provided when prescribing super-, high-, and midpotency topical steroids?
»	Why is the vehicle important when recommending a topical corticosteroid?
»	Are certain vehicles preferred for particular types of lesions or anatomic sites?
»	A patient has 5% total body surface area (TBSA) involvement. How much topical steroid should be prescribed for twice daily application for a 1-week-on and 1-week-off treatment cycle? The patient will return in 4 weeks for follow-up.
»	How should the FTU application technique be applied to children?
»	When are combination topical steroid and antiinfective products indicated?
»	What is tachyphylaxis and how can it be prevented?
»	What are the local cutaneous side effects of topical steroids?
»	What are the effects of topical steroids on the epidermis?
»	What are the effects of topical steroids on the dermis?
»	What are the systemic side effects of topical steroid therapy?
»	Are there topical steroid addicts?
»	What is periorificial dermatitis?
»	What is tinea incognito?
»	Can topical steroid medications cause contact dermatitis?
»	Mrs. Jones brings her 9-month-old infant with moderate atopic dermatitis to your office. What topical steroid do you prescribe?
»	A 40-year-old woman presents with a 5-year history of chronic dermatitis on her palms. Lesions are plaques with abundant scale. What topical steroid do you prescribe?
»	A 35-year-old woman with moderate psoriasis presents with scalp, facial, and body plaque lesions. What topical steroid do you prescribe?
»	Mrs. Smith brings her 6-month-old infant with a 2-week history of diaper dermatitis to your office. What topical steroid do you prescribe? Would you recommend any other topical therapy?
»	List some common mistakes that are made when prescribing a topical steroid.

What specific directions should be provided when prescribing super-, high-, and midpotency topical steroids?

Education is imperative. Side effects should be discussed, as well as correct application methods to avoid misuse. Failure to do so may result in nonadherence and irrational steroid phobia. Timely follow-up should be scheduled to monitor for treatment and side effects.

The directions should specify that the potent topical steroid should not be used in areas of thin skin (e.g., face, neck), and in intertriginous locations where skin touches skin (e.g., axilla, inframammary, infrapannus, groin). Areas of thinner epidermis provide less resistance and facilitate absorption. In addition, apposition of two skin surfaces simulates an occlusive dressing, which greatly enhances penetration and absorption of medication.

Because it is common for patients to distribute their medication to other family members or friends, or save it for use on another skin problem in the future, instructions should include exclusive use by the patient only and for this particular rash only.

Charman CR, Morris AD, Williams HC: Topical corticosteroid phobia in patients with atopic eczema, Br J Dermatol 142(5):931–936, 2000.