[Local corticosteroid therapy in dermatology].
FOUR LEVELS OF ACTION: The introduction of dermocorticosteroids (corticosteroids for topical application) has revolutionized management of many skin diseases. Depending on their antiinflammatory action, these products can be classed into four levels of action. Dermocorticosteroids have antiinflammatory, vasoconstrictor, antiproliferative, antisynthetic and immunosuppressive actions. SKIN PENETRATION: Penetration depends on the intrinsic characteristics of the drug, but also on many other factors including the nature of the excipient, additives, occlusion, localization, nature of the treated skin disease, and patient age. There is a reservoir effect, explaining why a single application is effective for dermatoses with a normal keratin layer. INDICATIONS AND CONTRAINDICATIONS: Dermocorticosteroids can be indicated in numerous inflammatory skin diseases (psoriasis, eczema ...). They are formally contraindicated in case of skin infections, diaper rash, acne and rosacea. Contact allergies have been reported.


CONCLUSIONS
The choice of a dermatocorticosteroid depends on the suspected sensitivity of the disease to treat, its degree of extension, and its localization as well as the patient's age and the planned duration of treatment. Cremes provide good cosmetic satisfaction. The number of tubes to be used must be strictly controlled. Occlusion is indicated in case of palmo-plantar or the scalp involvement.
Chosidow
O
O
Service de Médecine interne, Groupe Hospitalier Pitié-Salpêtrière, Paris. olivier.chosidow@psl.ap-hop-paris.fr
Lebrun-Vignes
B
B
Bourgault-Villada
I
I
D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000075202:Contraindications; D006801:Humans; D012871:Skin Diseases / Q000188:drug therapy* / Q000209:etiology; D013256:Steroids; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D013256:Steroids