Corticosteroids: options in the era of steroid-sparing therapy.
Topical corticosteroids remain the most commonly used topical treatments for inflammatory dermatoses, including psoriasis and atopic dermatitis. Topical corticosteroids are available in a variety of vehicles-creams, ointments, lotions, gels, and, more recently, foam. The vehicle used can substantially affect the individual agent's clinical action, potency, and acceptability to the patient. Moreover, some vehicles are better suited for specific body areas. Selection of the appropriate product should be determined by area of usage, physician experience, cost, and patient preference, particularly regarding vehicle. Although topical corticosteroids are associated with several side effects, including skin atrophy, telangiectases, purpura, and striae formation, appropriate usage can minimize these occurrences. Judicious use includes short-term, appropriate application as initial monotherapy or in combination strategies with other therapeutic agents that ideally possess complementing mechanisms of action. Examples include pulsing with high-potency topical corticosteroids and combination regimens with other topical agents such as topical calcineurin inhibitors, calcipotriene, or tazarotene. Appropriate education of patients and caregivers alike will facilitate the optimal use of these medications.
Del Rosso
James
J
Department of Dermatology, University of Nevada School of Medicine, Las Vegas, Nevada, USA.
Friedlander
Sheila Fallon
SF
D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D065095:Calcineurin Inhibitors; D002117:Calcitriol / Q000031:analogs & derivatives / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D003876:Dermatitis, Atopic / Q000188:drug therapy*; D004304:Dosage Forms; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007223:Infant; D009539:Nicotinic Acids / Q000627:therapeutic use; D011565:Psoriasis / Q000188:drug therapy*; D014467:Ultraviolet Therapy; D012176:Retinoids
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D065095:Calcineurin Inhibitors; D002117:Calcitriol; D004304:Dosage Forms; D007166:Immunosuppressive Agents; D009539:Nicotinic Acids; C055085:calcipotriene; C086827:tazarotene; D012176:Retinoids