Treatment applied to the skin that is directed at the skin.
Exposure is largely limited to the skin. There is a decreased risk of systemic side effects, but sometimes there is a little bit of systemic absorption.
Consists of... a vehicle and active ingredient(s)
Types of Vehicles
Cream (semi-solid emulsions)
Gel (think hair gel)
Semi-solid emulsions and are generally preferred by patients for short-term use
Greasy, similar to plain petrolatum
Generally, ointments are more potent than creams
More dilute than creams
Easier to use in hairy areas
Cosmetically the most acceptable
May be drying and irritating to the skin
Topical Steroid Potency
Can range from 1800x from the weakest to the strongest
Typically... hydrocorisone is the weakest, betamethasone valerate is intermediate, and clobetasol is very strong.
One of the most powerful topical steroids
Prescribe to thick areas such as the soles of the feet or the palms of the hands
A "middle of the road" topical corticosteroid
Good for treating the torso, arms and legs
A quite weak topical corticosteroid
Good for treating the face or body folds
Side Effects of Topical Steroids
The greatest side effect of topical steroids is skin atrophy
Of the epidermis, dermis, and even subcutis.
Atrophy leads to bruising, telangiectasia, fragile skin, easily irritated skin, and striae (stretch marks).
Loss of effect with prolonged use.
Topical corticosteroids can suffer from this.
Topical Calcineurin Inhibitors
Are non-steroidal anti-inflammatories but do not have any skin atrophy or other steroid effects.
Typical side effects can include burning and stinging.
These can be used alone or in conjunction with topical steroids. If steroids are like a "fire extinguisher", TCIs are like "fire retardant".