Eczema

Question 1

Topical corticosteroids

Hydrocortisone, betamethasone

Common indications

Answer 1

• Used in inflammatory skin conditions e.g. eczema, to treat disease flares or to control chronic disease where emollients alone are ineffective

Question 2

Topical corticosteroids

Hydrocortisone

Answer 2

• Corticosteroids have immunosuppressive, metabolic and mineralocorticoid effects.
• Where corticosteroids are applied topically, effects are mostly limited to the site of application. With potent or prolonged use of topical corticosteroids, systemic absorption and effects can occur.
• Topical corticosteroids can be classified as being mild, moderately potent, potent and very potent, depending on the type and concentration of corticosteroid in the formulation. Of the examples given, hydrocortisone 0.1–2.5% is mild and betamethasone valerate 0.1% as potent.

Question 3

Topical corticosteroid

Important adverse effects

Answer 3

• Adverse effects are uncommon with mild or moderately potent topical corticosteroids. However, potent and very potent topical corticosteroids can cause local adverse effects such as skin thinning, striae, telangiectasia and contact dermatitis.
• When used on the face, they can cause perioral dermatitis and cause or exacerbate acne. Withdrawal of topical corticosteroids can cause a rebound worsening of the underlying skin condition.
• Rarely, adrenal suppression and systemic adverse effects occur

Question 4

Topical Corticosteroids

Warnings

Answer 4

• You should not use topical corticosteroids where the infection is present as this can cause the infection to worsen or spread
• Where facial lesions are present, potent corticosteroids should be avoided and treatment courses should be short

Question 5

Topical Corticosteroids

Important interactions

Answer 5

• There are generally no significant drug interactions when corticosteroids are used topically
• If several topical agents are being used on the same area of skin, applications should be spaced out to allow absorptions of pharmacologically active agent, emollients should be applied last

Question 6

Topical corticosteroids

Hydrocortisone, betamethasone

Prescription

Answer 6

• General advice when prescribing topical corticosteroids is to use as mild a corticosteroid as possible for as short a time as possible, usually for no more than 2 weeks (1 week for facial lesions).
• When prescribing for eczema, choose mild corticosteroids for mild flares, moderately potent corticosteroids for moderate flares and potent corticosteroids for severe flares.

Question 7

Topical corticosteroids

Communication

Answer 7

• These should be applied thinly and only to the areas of skin where the disease is active
• Generally takes 1-2 weeks to take effect
• Warn them of the risk of skin damage if the treatment is applied to the wrong areas for too long

Question 8

Emollients

Common indications

Answer 8

• As a topical treatment for all dry or scaling skin disorders
• Specifically, they are used along or in combination with topical corticosteroids in the treatment of eczema
• They can reduce skin dryness and cracking in psoriasis, where, depending on severity, they are used alone or in combination with other therapies

Question 9

Emollients

MOA

Answer 9

• Replace water content in dry skin
• They contain oils or paraffin-based products that help to soften the skin and reduce water loss by reducing evaporation

Question 10

Emollients

Adverse effects and warnings

Answer 10

• Greasiness- patients may not like this
• Exacerbate acne vulgaris and folliculitis by blocking pores and hair follicles
• While these drugs are usually very safe to use, paraffin-based emollients are significant fire hazards

Question 11

Topical corticosteroids

Potencies

Answer 11

• Mild
  
  • Hydrocortisone, Synalar
• Moderate
  
  • Betamethasone-RD (Betnovate-RD), Clobetasone (Eumovate),
• Potent
  
  • Beclometasone, Betamethasone, Mometasone
• Very Potent
  
  • Clobetasol,

Question 12

Topical corticosteroids

Direction for administration

Answer 12

• Topical corticosteroid preps should not be applied more than BD, often OD is sufficient
• Fingertip unit- sufficient to cover an area that is twice that of the flat adult handprint
• Mixing topical preparations should be avoided where possible. Several minutes should elapse between application of different preparation.