Vehicle used with topical steroid

The choice of vehicle can affect the use and penetration of the medication resulting in varying in potency of a particular topical steroid (1). Numerous types of vehicle formulations are available and the selection depends on the type of lesion and the area of the body affected (2).

• ointments
  • petrolatum based and provides more lubrication and occlusion (increases absorption) when compared to other preparations (3)
  • useful in treating dry or thick, hyperkeratotic lesions and for areas with thick skin (like in palms and soles) (2)
  • should not be applied to hairy areas and if used on intertriginous areas may result in maceration and folliculitis (3)
• creams
  • generally less potent than ointments, it has good lubricating qualities and are cosmetically more acceptable to patients
  • useful in treatment of moist and weeping areas of the skin (4)
  • may cause irritation, stinging, and allergic reaction to preservatives it contains (3)
• gels
  • non-greasy and non-occlusive and used for hairy or facial areas (3)
  • useful for exudative inflammation e.g. – poison ivy (4)
• lotions
  • contain alcohol and used in hairy areas, leaves very little residue (3)
  • useful in conditions with acute inflammation or tenderness e.g. - acute contact dermatitis (4)
• foams, mousses, and shampoos
  • effective when used on the scalp
  • spreads easily resulting in increased permeability with little or no residue (4)

Reference:

• (1) 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
• (2) Lee NP, Arriola ER. Topical corticosteroids: back to basics. West J Med. 1999;171(5-6):351-3.
• (3) Ference JD, Last AR. Choosing topical corticosteroids. Am Fam Physician. 2009;79(2):135-40
• (4) Tadicherla S et al. Topical corticosteroids in dermatology. J Drugs Dermatol. 2009;8(12):1093-105