Choosing a topical steroid

Choosing a topical steroid

The choice of appropriate topical corticosteroids depends on the following:

• condition being treated
  • highly responsive conditions (atopic dermatitis) requires mild corticosteroid preparations
  • less responsive or refractory conditions (palmoplantar or nail psoriasis, lupus erythematosus) needs more potent agents (1)
• anatomic area of application
  • areas with thin skin (scrotum, parts of the face) or areas of occlusion (groin, axillae, other intertrigenous areas) - moderate to low potent preparations. However in conditions such as lichen sclerosus or discoid lupus erythematosus and conditions which are resistant to lower potent preparations - high potent preperations (1,2)
  • areas with thick skin (palms and soles) and for thick, chronic plaques - requires a more potent preparation (1,3)
  • for large surface area - low-to-moderate potent preparations are preferred due to increased risk of systemic absorption (1)
• age of the patient
  • in geriatric patients use of high potent agents should be avoided due to the increased risk of adverse effects (1)
  • more potent preparations and halogenated moderate potent preparations are not used in infants and children (3)

Reference:

• 1. Lee NP, Arriola ER. Topical corticosteroids: back to basics. West J Med. 1999;171(5-6):351-3.
• 2. Tadicherla S et al. Topical corticosteroids in dermatology. J Drugs Dermatol. 2009;8(12):1093-105
• 3. Menter A et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies. J Am Acad Dermatol. 2009;60(4):643-59
• 4. Tadicherla S et al. Topical corticosteroids in dermatology. J Drugs Dermatol. 2009;8(12):1093-105