Dosing & Uses
Dosage Forms & Strengths
topical cream
- 0.1%
- 0.2%
- 0.5%
- 1%
- 2.5%
topical lotion
- 0.1%
- 1%
- 2%
- 2.5%
topical gel
- 1%
- 10%
topical solution
- 1%
- 2.5%
topical ointment
- 0.2%
- 0.5%
- 1%
- 2.5%
Atopic Dermatitis
Apply thin film to affected area BID
Corticosteroid-responsive Dermatoses
Relief of inflammatory and pruritic manifestations
Hydrocortisone base: q6-12hr
Hydrocortisone acetate: q6-12hr
Hydrocortisone butyrate: q8-12hr
Hydrocortisone valerate: q8-12hr
Dosage Forms & Strengths
topical cream
- 0.1%
- 0.2%
- 0.5%
- 1%
- 2.5%
topical lotion
- 0.5%
- 1%
- 2%
- 2.5%
topical gel
- 1%
topical solution
- 1%
- 2.5%
topical ointment
- 0.2%
- 0.5%
- 1%
- 2.5%
Corticosteroid-responsive Dermatoses
Relief of inflammatory and pruritic manifestations
Infants, children, and adolescents; products for OTC use are not labeled for use in children <2 years
Hydrocortisone base: q6-12hr
Hydrocortisone acetate: q6-12hr
Hydrocortisone butyrate: q8-12hr
Dosing considerations
- Limit to the minimum amount necessary for therapeutic efficacy
Atopic Dermatitis
<3 months: Safety and efficacy not established
>3 months: Apply film to affected area q12hr
Adverse Effects
Frequency Not Defined
Skin atrophy
Striae
Acneform lesions
Perioral dermatitis
Folliculitis
Itching
Pigmentation changes
HPA suppression (with higher potency used >2 wk)
Warnings
Contraindications
Underlying infection
Hypersensitivity
Ophthalmic use
Treatment of diaper dermatitis
Cautions
Chronic topical corticosteroid therapy may interfere with growth and development in children
Use lower potency in children; may absorb proportionally larger amounts after topical application and may cause systemic effects
Occlussive dressings, prolonged use, application to large surface areas, or application to denuded skin, may increase percutaneous absorption, which may result in cushing syndrome, glycosuria, and hyperglycemia
Prolonged use may increase risk of Kaposi's sarcoma
Prolonged use may increase risk of secondary infection, may mask acute infection, limit response to vaccines, and prolong or exacerbate viral infections; avoid exposure to measles or chickenpox while receiving therapy; not for the treatment of ocular herpes simplex, cerebral malaria, fungal infections, or viral hepatitis; observe patients with latent tuberculosis closely; restric use in active tuberculosis
Acute myopathy reported with high dose corticosteroids, especially patients with neuromuscular transmission disorders
Psychiatric disturbances including euphoria, insomnia, mood swings, and personality changes reported with corticosteroid use
Allergic contact dermatitis may occur; diagnosed as failure to heal rather than exacerbation; discontinue therapy and treat appropriately if it occurs
May suppress hypothalamic-pituitary-adrenal axis, especially in patients receiving high doses for prolonged periods of time and younger children, which may result in adrenal crisis
Anaphylactoid reactions reported in patients receiving corticosteroids
Local desensitization (irritation, redness) reported; discontinue if it occurs
Use caution in patients with diabetes, cardiovascular disease, hepatic impairment, myocardial infarction, myasthenia gravis, osteoporosis, ocular disease, renal impairment, or thyroid disease
Pregnancy & Lactation
Pregnancy
There are no adequate and well-controlled studies in pregnant women on teratogenic effects from topically applied corticosteroids; corticosteroids generally teratogenic in laboratory animals when administered systemically at relatively low dosage levels; topical corticosteroids should be used during pregnancy only if potential benefits justify potential risk to fetus; should not be used extensively on pregnant patients, in large amounts, or for prolonged periods of time
Lactation
Not know whether topical administration could result in sufficient systemic absorption to produce detectable quantities in breast milk; systemically administered corticosteroids are secreted into breast milk in quantitis not likely to have deleterious effect on infant; nevertheless, caution should be exercised when topical corticosteroids are administered to a nursing woman
Pregnancy Categories
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Pharmacology
Mechanism of Action
Decreases inflammation by stabilizing leukocyte lysosomal membranes, preventing release of destructive acid hydrolases from leukocytes
Inhibits macrophage accumulation in inflamed areas
Reduces leukocyte adhesion to capillary endothelium
Reduces capillary wall permeability and edema formation
Decreases complement components and antagonizes histamine activity and release of kinin from substrates
Reduces fibroblast proliferation, collagen deposition, and subsequent scar tissue formation
Absorption
Percutaneous; extent of absorption in dependent on formulation, epidermal integrity (intact vs abrated), and the use of occlusive dressings
Images
Patient Handout
Formulary
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