![]() ![]() 13 However, the specific molecular structure (eg betamethasone valerate or dipropionate), formulation (cream, ointment or solution) and percentage (eg 0.05% or 0.1%) all affect the potency. The potency of TCS agents has been historically measured by the intensity of the vasoconstrictive effect. Topical steroid selection and potency categories This article highlights the various potency categories of TCS agents for effective treatment of dermatoses from the general practice perspective. 9–12 Therefore, it is important to determine the potency of the TCS correctly for treatment. In addition, there are variable classification systems for the potency of TCS agents. These variations affect the potency, efficacy and effect. How simple is it, and what do we need to know to select the correct TCS for effective treatment of a particular condition? TCS agents have different formulations, percentages and molecular structures despite similar or near-similar names. 1–8 Therefore, selection of TCS agents for effective treatment without undesirable effects is essential. However, studies have shown the existence of steroid phobia among non-dermatologist professionals (eg general practitioners and pharmacists) as well as patients and parents, evidence of non-adherence and unresolved outcomes of skin conditions affecting quality of life and healthcare costs. If a favorable response does not occur promptly, the corticosteroid should be discontinued until the infection has been adequately controlled.Various topical corticosteroid (TCS) agents and potencies are available for the treatment of dermatological disorders such as atopic dermatitis, contact dermatitis, psoriasis and lichenoid disorders in patients of all ages. In the presence of dermatological infections, the use of an appropriate antifungal or antibacterial agent should be instituted. If irritation develops, topical corticosteroids should be discontinued and appropriate therapy instituted. Pediatric patients may absorb proportionally larger amounts of topical corticosteroids and thus be more susceptible to systemic toxicity (See ![]() Infrequently, signs and symptoms of steroid withdrawal may occur, requiring supplemental systemic corticosteroids. Recovery of HPA axis function is generally prompt and complete upon discontinuation of the drug. If HPA axis suppression is noted, an attempt should be made to withdraw the drug, to reduce the frequency of application, or to substitute a less potent steroid. Therefore, patients receiving a large dose of a potent topical steroid applied to a large surface area or under an occlusive dressing should be evaluated periodically for evidence of HPA axis suppression by using the urinary free cortisol and ACTH stimulation tests. Conditions which augment systemic absorption include the application of the more potent steroids, use over large surface areas, prolonged use, and the addition of occlusive dressings. Systemic absorption of topical corticosteroids has produced reversible hypothalamic-pituitary-adrenal (HPA) axis suppression, manifestations of Cushing’s syndrome, hyperglycemia, and glucosuria in some patients. Some of the topical corticosteroids and their metabolites are also excreted into the bile. Corticosteroids are metabolized primarily in the liver and are then excreted by the kidneys. Corticosteroids are bound to plasma proteins in varying degrees. Once absorbed through the skin, topical corticosteroids are handled through pharmacokinetic pathways similar to systemically administered corticosteroids. Thus, occlusive dressings may be a valuable therapeutic adjunct for treatment of resistant dermatoses. Occlusive dressings substantially increase the percutaneous absorption of topical corticosteroids. Inflammation and/or other disease processes in the skin increase percutaneous absorption. Topical corticosteroids can be absorbed from normal intact skin. The extent of percutaneous absorption of topical corticosteroids is determined by many factors including the vehicle, the integrity of the epidermal barrier, and the use of occlusive dressings. Related/similar drugs Cosentyx, Entyvio, Stelara, Taltz, Tremfya, prednisone, hydroxyzine Pharmacokinetics ![]()
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