Frequency of administration and duration of treatment of a topical corticosteroid

Generally, once or twice daily application is recommended for most topical steroids regardless of the potency (1)

• more frequent applications may be necessary in skin with thick stratum corneum
• intermittent scheduling (e.g. - every other day, weekends only) can be used as maintenance therapy of chronic conditions
• very potent or potent preparations should be managed by dermatologists (2)
• nonmedicated emollient creams or ointments can be used daily as a substitute during drug free intervals (1)

Topical steroids are generally used in short bursts to treat exacerbations of a disease so the duration of treatment is generally between 3 - 7 days (3)

• regular use for more than four weeks is not recommended for any topical corticosteroid without review
• use of potent preparations regularly for more than 7 days should be avoided (2)
• repeat prescriptions should be under supervision and the patient should be reviewed regularly (2)
• tolerance and tachyphylaxis may occur in response to chronic use of topical steroids (4)

Clinicians should attempt to alternate between topical corticosteroids and non-corticosteroid preparations (2). In patients who do not have improvement of symptoms after 3-7 days, diagnosis should be reassessed and the following conditions should be considered as the cause

• infection
• hypersensitivity reaction to the base or the steroid
• non compliance of the patients due to the concerns about side effects of steroids
• tolerance or tachyphylaxis - alternative steroids with the same potency can be used in these patients (3)

Reference:

• 1. Lee NP, Arriola ER. Topical corticosteroids: back to basics. West J Med. 1999;171(5-6):351-3.
• 2. British Association of Dermatologists. Psoriasis. General management - Topical corticosteroids
• 3. MeReC. Using topical corticosteroids in general practice. MeReC Bulletin 1999;10(6), 21-24
• 4. Ference JD, Last AR. Choosing topical corticosteroids. Am Fam Physician. 2009;79(2):135-40