Topical Steroids
Dosing principles:- The strength of topical steroid (potent, weak)must be decided based on clinical condition and severity
- Long term continuous therapy should be avoided in all patients irrespective of age
- Risk factors for increasing local and systemic toxicity:
- Prolonged use over large surface areas
- Children (small body surface area)
- Potent formula
- Application to thin skin areas (join flexors, face, neck, groin)
- With polythene occlusive dressings
- Use in occluded areas of skin such as the nappy area (prolongs biological half-life)
- Use on broken skin or other conditions where the skin barrier may be impaired
- Careful follow-up is essential especially when using potent steroids
- Adrenal suppression is likely to occur in cases of longer therapy with potent formulations
- Avoid pre-prepared mixtures of: steroids, antihistamine, antimicrobial unless prescribed by the treating clinician or specialist
- Use of a combination product consisting of a mixture of steroid and antifungal agent is not recommended
- Provisionally, 0.5% or less of hydrocortisone should be used on the face. Strength must be confirmed by the treating clinician or specialist based on patient profile and severity of the condition
Choice of preparation:- Creams are best suited for moist or weeping lesions
- Ointments are best suited for dry lesions
- Lotions are useful for scalp lesions or hairy areas of the body
- Emollients can be applied over topical steroids (percentage must be determined by the treating clinician or specialist)