Skip to main content
SpringerLink
Log in

Rational Use of Topical Corticosteroids

  • Chapter
  • First Online:
A Treatise on Topical Corticosteroids in Dermatology

  • 1203 Accesses

Abstract

Topical corticosteroids (TCs) have been the backbone of a dermatologist’s therapeutic armamentarium to treat various steroid-responsive dermatoses. They are available in different strengths and molecular and vehicular formulations that give dermatologist great flexibility to treat diseases of varying severity present at different anatomic sites in patients of different age groups.

However, many of these advantages of TCs have been negated by the frequent instances of misuse and abuse of these drugs by dermatologists, general physicians, and patients alike. This has increased cases with known adverse effects of TC as well as revealed unique TC-induced dermatoses among users. The dermatologist owes the society a responsibility to disseminate proper knowledge regarding when, where, and how to use TC and promote their rational and ethical use. The benefits of proper and appropriate use and the harm of unsupervised overuse in correct indications, misuse for cosmetic purposes, and underuse due to incomplete knowledge or irrational fears need to be clearly conveyed using all available medical, legal, and political resources.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Stern R. The pattern of topical corticosteroid prescribing in the United States 1989–1991. J Am Acad Dermatol. 1996;35:183–96.

    Article  CAS  PubMed  Google Scholar 

  2. Sulzberger MB, Witten VH. The effect of topically applied compound F in selected dermatoses. J Invest Dermatol. 1952;19:101–2.

    Article  CAS  PubMed  Google Scholar 

  3. Kumar AM, Noushad PP, Shailaja K, Jayasutha J, Ramasamy C. A study on drug prescribing pattern and use of corticosteroids in dermatological conditions at tertiary care teaching hospital. Int J Pharm Sci Rev Res. 2011;9:132–5.

    Google Scholar 

  4. Rathi SK, D’Souza P. Rational and ethical use of topical corticosteroids based on safety and efficacy. Indian J Dermatol. 2012;57:251–9.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kumar S, Goyal A, Gupta YK. Abuse of topical corticosteroids in India: concerns and the way forward. J Pharmacol Pharmacother. 2016;7(1):1–5. doi:10.4103/0976-500X.179364.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hajar T, Leshem YA, Hanifin JM, Nedorost ST, Lio PA, Paller AS, et al. (The National Eczema Association Task Force); A systematic review of topical corticosteroid withdrawal (“steroid addiction”) in patients with atopic dermatitis and other dermatoses. J Am Acad Dermatol. 2015;72(3):541–549.e2. doi:10.1016/j.jaad.2014.11.024.

    Article  CAS  PubMed  Google Scholar 

  7. Shakya Shrestha S, Bhandari M, Shrestha R, Thapa SR, Karki A, Prajapati M, et al. Study on corticosteroids use pattern in dermatological practice and investigating adverse effect of corticosteroids including its associated factors. Kathmandu Univ Med J (KUMJ). 2015;13(51):261–7.

    CAS  Google Scholar 

  8. Müller SM, Tomaschett D, Euler S, Vogt DR, Herzog L, Itin P. Topical corticosteroid concerns in dermatological outpatients: a cross-sectional and interventional study. Dermatology. 2016;232(4):444–52.

    Article  PubMed  Google Scholar 

  9. Ference JD, Last AR. Choosing topical corticosteroids. Am Fam Physician. 2009;79:135–40.

    PubMed  Google Scholar 

  10. Jha AK, Sinha R, Prasad S. Misuse of topical corticosteroids on the face: a cross-sectional study among dermatology outpatients. Indian Dermatol Online J. 2016;7(4):259–63.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rathi S. Abuse of topical steroid as cosmetic cream: a social background of steroid dermatitis. Indian J Dermatol. 2006;51:154–5.

    Article  Google Scholar 

  12. Bhat YJ, Manzoor S, Qayoom S. Steroid induced rosacea: a clinical study of 200 patients. Indian J Dermatol. 2011;56:30–2.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Al-Dhalimi MA, Aljawahiri N. Misuse of topical corticosteroids: a clinical study from an Iraqi hospital. East Mediterr Health J. 2006;12:847–52.

    CAS  PubMed  Google Scholar 

  14. Solomon BA, Glass AT, Rabbin PE. Tinea incognito and “over the-counter” potent topical steroids. Cutis. 1996;58:295–6.

    CAS  PubMed  Google Scholar 

  15. Verma SB. Sales, status, prescriptions and regulatory problems with topical steroids in India. Indian J Dermatol Venereol Leprol. 2014;80:201–3.

    Article  PubMed  Google Scholar 

  16. Malangu N, Ogunbanjo G. Predictors of topical steroid misuse among patrons of pharmacies in Pretoria. SA Fam Pract. 2006;48:14.

    Google Scholar 

  17. Saraswat A, Lahiri K, Chatterjee M, Barua S, Coondoo A, Mittal A, et al. Topical corticosteroid abuse on the face: a prospective, multicentre study of dermatology outpatients. Indian J Dermatol Venereol Leprol. 2011;77:160–6.

    Article  PubMed  Google Scholar 

  18. Lee JY, Her Y, Kim CW, Kim SS. Topical corticosteroid phobia among parents of children with atopic eczema in Korea. Ann Dermatol. 2015;27(5):499–506.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Giannotti B. Current treatment guidelines for topical corticosteroids. Drugs. 1988;36(Suppl 5):9–14.

    Article  PubMed  Google Scholar 

  20. Gonzalez-Moles MA, Scully C. Vesiculo-erosive oral mucosal disease management with topical corticosteroids: (1) fundamental principles and specific agents available. J Dent Res. 2005;84:294–301.

    Article  CAS  PubMed  Google Scholar 

  21. Valencia IC, Kerdel KA. Topical corticosteroids. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors. Fitzpatrick’s dermatology in general medicine. 7th ed. New York, NY: McGraw-Hill; 2008.

    Google Scholar 

  22. Ulff E, Maroti M, Serup J, Nilsson M, Falkmer U. Prophylactic treatment with a potent corticosteroid cream ameliorates radiodermatitis, independent of radiation schedule: a randomized double blinded study. Radiother Oncol. 2017;122:50–3. doi:10.1016/j.radonc.2016.11.013.

    Article  CAS  PubMed  Google Scholar 

  23. Mc Kenzie AW, Stoughton RB. Method for comparing percutaneous absorption of steroids. Arch Dermatol. 1962;86:608–10.

    Article  Google Scholar 

  24. Goa KL. Clinical pharmacology and pharmacokinetic properties of topically applied corticosteroids. A review. Drugs. 1988;36(Suppl 5):51–61.

    Article  PubMed  Google Scholar 

  25. Mc Kenzie AW. Comparison of steroids by vasoconstriction. Br J Dermatol. 1966;78:182–3.

    Article  CAS  Google Scholar 

  26. Olsen EA. A double-blind controlled comparison of generic and trade-name topical steroids using the vasoconstriction assay. Arch Dermatol. 1991;127:197–201.

    Article  CAS  PubMed  Google Scholar 

  27. MeReC. Using topical corticosteroids in general practice. MeReC Bull. 1999;10(6):21–4.

    Google Scholar 

  28. Drake LA, Dinehart SM, Farmer ER, Goltz RW, Graham GF, Hordinsky MK, et al. Guidelines of care for the use of topical glucocorticosteroids. J Am Acad Dermatol. 1996;35:615–9.

    Article  CAS  PubMed  Google Scholar 

  29. Epstein NN, Epstein WI, Epstein JH. Atrophic striae in patients with inguinal intertrigo. Arch Dermatol. 1963;87:450–5.

    Article  Google Scholar 

  30. Mukhopadhyay AK, Baghel V. A study to evaluate the efficacy and safety of hydrocortisone aceponate 0.127% lipophilic cream in steroid responsive dermatoses in Indian patients. Indian J Dermatol Venereol Leprol. 2010;76:591.

    PubMed  Google Scholar 

  31. Jacob SE, Steele T. Corticosteroid classes: a quick reference guide including patch test substance and cross-reactivity. J Am Acad Dermatol. 2006;54:723–7.

    Article  PubMed  Google Scholar 

  32. Rathod SS, Motghare VM, Deshmukh VS, Deshpande RP, Bhamare CG. Prescribing practices of topical corticosteroids in the outpatient dermatology Department of a Rural Tertiary Care Teaching Hospital. Indian J Dermatol. 2013;58(5):342–5.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Lee NP, Arriola ER. Topical corticosteroids. Back to basics. West J Med. 1999;171:351–3.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Sheman AJ. Proper use of topical corticosteroids. In: Frankel DH, editor. Field guide to clinical dermatology. 2nd ed. Northvale, NJ: LWW; 2006. p. 3.

    Google Scholar 

  35. Maibach HI. In vivo percutaneous penetration of corticosteroids in man and unresolved problems in the efficacy. Dermatologica. 1976;152(Suppl 1):11–25.

    Article  CAS  PubMed  Google Scholar 

  36. Eroğlu İ, Azizoğlu E, Özyazıcı M, Nenni M, Gürer Orhan H, Özbal S, et al. Effective topical delivery systems for corticosteroids: dermatological and histological evaluations. Drug Deliv. 2016;23(5):1502–13.

    PubMed  Google Scholar 

  37. Pariser DM. Topical steroids: a guide for use in the elderly patients. Geriatrics. 1991;46:51–4. 57–60

    CAS  PubMed  Google Scholar 

  38. Long CC, Finlay AY. The finger-tip unit-a new practical measure. Clin Exp Dermatol. 1991;16:444–7.

    Article  CAS  PubMed  Google Scholar 

  39. Tadicherla S, Ross K, Shenefelt PD, Fenske NA. Topical corticosteroids in dermatology. J Drugs Dermatol. 2009;8:1093–105.

    PubMed  Google Scholar 

  40. Carlos G, Uribe P, Fernández-Peñas P. Rational use of topical corticosteroids. Aust Prescr. 2013;36:5–61.

    Article  Google Scholar 

  41. National Institute for Health and Care Excellence, Clinical Knowledge Summaries. Corticosteroids–topical (skin), nose, and eyes. Last revised August 2010 quoted in NHS Prescqipp Bulletin 116: Topical corticosteroids. 2015. Accessed via https://www.prescqipp.info/topical-corticosteroids/category/228-topical-corticosteroids.

  42. Brazzini B, Pimpinelli N. New and established topical corticosteroids in dermatology: clinical pharmacology and therapeutic use. Am J Clin Dermatol. 2002;3:47–58.

    Article  PubMed  Google Scholar 

  43. du Vivier A. Tachyphylaxis to topically applied steroids. Arch Dermatol. 1976;112:1245–8.

    Article  PubMed  Google Scholar 

  44. NICE. Appraisal consultation document of application of topical corticosteroids for atopic eczema. National Institute for Health and Clinical Excellence. 2004. Available from https://www.nice.org.uk/guidance/ta81/documents/appraisal-consultation-document-frequency-of-application-of-topical-corticosteroids-for-atopic-eczema. Accessed 19 Jan 2017.

  45. Abidi A, Ahmad F, Singh SK, Kumar A. Study of reservoir effect of clobetasol propionate cream in an experimental animal model using histamine-induced wheal suppression test. Indian J Dermatol. 2010;55:329–33.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Lagos B, Mibach H. Frequency of application of topical corticosteroids: an overview. Br J Dermatol. 1998;139:763–6.

    Article  CAS  PubMed  Google Scholar 

  47. National Institute for Health and Care Excellence (NICE): Atopic eczema in children—Management of atopic eczema in children from birth up to the age of 12 years. [CG57] London: National Collaborating Centre for Women’s and Children’s Health; 2007. http://www.nice.org.uk/guidance/CG57/chapter/1-Guidance. Accessed 19 Jan 2017.

  48. Sathish Kumar D, Moss C. Topical therapy in atopic dermatitis in children. Indian J Dermatol. 2016;61(6):656–61.

    Article  Google Scholar 

  49. NHS Prescqipp Bulletin 116: Topical corticosteroids. 2015. Accessed via https://www.prescqipp.info/topical-corticosteroids/category/228-topical-corticosteroids. Accessed 12 Jan 2017.

  50. Feldmann RJ, Maibach HI. Regional variation in percutaneous penetration of 14C cortisol in man. J Invest Dermatol. 1967;48:181–3.

    Article  CAS  PubMed  Google Scholar 

  51. Saraswat A. Topical corticosteroid use in children: adverse effects and how to minimize them. Indian J Dermatol Venereol Leprol. 2010;76:225–8.

    Article  PubMed  Google Scholar 

  52. Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006;54:1–15.

    Article  PubMed  Google Scholar 

  53. Prescribing medicines in pregnancy database: Australian Government-Department of health Therapeutic goods administration via https://www.tga.gov.au/prescribing-medicines-pregnancy-database#searchname. Accessed 15 Jan 2017.

  54. Chi CC, Wang SH, Kirtschig G. Safety of topical corticosteroids in pregnancy. JAMA Dermatol. 2016;152(8):934–5.

    Article  PubMed  Google Scholar 

  55. Khobragade KJ. Efficacy and safety of combination ointment fluticasone propionate 0.005% plus mupirocin 2% for the treatment of atopic dermatitis with clinical suspicion of secondary bacterial infection: an open label uncontrolled study. Indian J Dermatol Venreol Leprol. 2005;71:92–6.

    Google Scholar 

  56. Havlickova B, Friedrich M. The advantages of topical combination therapy in the treatment of inflammatory dermatomycoses. Mycoses. 2008;51(Suppl 4):16–26.

    Article  CAS  PubMed  Google Scholar 

  57. Rigopoulos D, Larios G, Gregoriou S, Alevizos A. Acute and chronic paronychia. Am Fam Physician. 2008;77(3):339–46.

    PubMed  Google Scholar 

  58. Koo J, Cuffie CA, Tanner DJ, Bressinck R, Cornell RC, DeVillez RL, et al. Mometasone furoate 0.1%-salicylic acid 5% ointment versus mometasone furoate 0.1% ointment in the treatment of moderate-to-severe psoriasis: a multicenter study. Clin Ther. 1998;20:283–91.

    Article  CAS  PubMed  Google Scholar 

  59. Papp KA, Guenther L, Boyden B, Larsen FG, Harvima RJ, Guilhou JJ, et al. Early onset of action and efficacy of a combination of calcipotriene and betamethasone dipropionate in the treatment of psoriasis. J Am Acad Dermatol. 2003;48:48–54.

    Article  PubMed  Google Scholar 

  60. Koo JY, Martin D. Investigator-masked comparison of tazarotene gel q.d. Plus mometasone furoate cream q.d. vs. mometasone furoate cream b.i.d. in the treatment of plaque psoriasis. Int J Dermatol. 2001;40:210–2.

    Article  CAS  PubMed  Google Scholar 

  61. Rajaratnam R, Halpern J, Salim A, Emmett C. Interventions for melasma. Cochrane Database Syst Rev. 2010;7:CD003538.

    Google Scholar 

  62. McFadden JP, Noble WC, Camp RD. Superantigenic exotoxin secreting potential of staphylococci isolated from eczematous skin. Br J Dermatol. 1993;128:631–2.

    Article  CAS  PubMed  Google Scholar 

  63. Dhar S, Kanwar AJ, Kaur S, Sharma P, Ganguly NK. Role of bacterial flora in the pathogenesis and management of atopic dermatitis. Indian J Med Res. 1992;95:234–8.

    CAS  PubMed  Google Scholar 

  64. Dhar S. Should topical antibacterials be routinely combined with topical steroids in the treatment of atopic dermatitis? Indian J Dermatol Venereol Leprol. 2005;71:71–2.

    Article  PubMed  Google Scholar 

  65. Guidelines for the management of atopic eczema. Primary Care Dermatology Society & British Association of Dermatologists . Available from https://www.nice.org.uk/guidance/ta81/resources/primary-care-dermatology-society2. Accessed on 22 Jan 2017.

  66. Kandhari R, Khunger N. Skin lightening agents-use or abuse? A retrospective analysis of topical preparations used by melasma patients of darker skin type. Indian J Dermatol Venereol Leprol. 2013;79(5):701–2.

    Article  PubMed  Google Scholar 

  67. Pellerano S. Use of a combination of an anti-inflammatory steroid, an antibacterial agent and an antifungal in dermatological practice. Int J Clin Pharmacol Ther Toxicol. 1985;23(4):215–8.

    CAS  PubMed  Google Scholar 

  68. Pazzaglia A. Clinical results obtained with a combination of an anti-inflammatory steroid, an antibacterial agent and an antifungal in dermatological outpatient practice. Int J Clin Pharmacol Ther Toxicol. 1985;23(7):367–72.

    CAS  PubMed  Google Scholar 

  69. Katz HI. Topical corticosteroids. Dermatol Clin. 1995;13:805–15. 6055

    CAS  PubMed  Google Scholar 

  70. Keipert JA, Kelly R. Temporary Cushing’s syndrome from percutaneous absorption of betamethasone 17-valerate. Med J Aust. 1971;1:542–4.

    CAS  PubMed  Google Scholar 

  71. Gilbertson EO, Spellman MC, Piacquadio DJ, Mulford MI. Super potent topical corticosteroid use associated with adrenal suppression: clinical considerations. J Am Acad Dermatol. 1998;38(2 Pt 2):318–21.

    Article  CAS  PubMed  Google Scholar 

  72. Ohman EM, Rogers S, Meenan FO, Mckenna TJ. Adrenal suppression following low-dose topical clobetasol propionate. JR Soc Med. 1987;80:422–4.

    Article  CAS  Google Scholar 

  73. Munro DD. The effect of percutaneously absorbed steroids on hypothalamic-pituitary-adrenal function after intensive use in inpatients. Br J Dermatol. 1976;94(Suppl 12):67–76.

    Article  PubMed  Google Scholar 

  74. Rathi SK, Kumrah L. Topical corticosteroid-induced rosacea like dermatitis: a clinical study of 110 cases. Indian J Dermatol Venereol Leprol. 2011;77:42–6.

    Article  PubMed  Google Scholar 

  75. Tollefson MM, Bruckner AL. Section on dermatology. Atopic dermatitis: skin-directed management. Pediatrics. 2014;134:e1735–44.

    Article  PubMed  Google Scholar 

  76. Smith SD, Lee A, Blaszczynski A, Fischer G. Attitudes of Australian dermatologists to the use and safety of topical corticosteroids in paediatric atopic dermatitis. Australas J Dermatol. 2015;57:278–83. doi:10.1111/ajd.12402.

    Article  Google Scholar 

  77. Mueller SM, Tomaschett D, Vogt DR, Itin P, Cozzio A, Surber C. Topical corticosteroid concerns from the clinicians’ perspective. J Dermatolog Treat. 2016:1–5. doi:10.1080/09546634.2016.1255307.

  78. Teasdale E, Muller I, Santer M. Carers’ views of topical-corticosteroid use in childhood eczema: a qualitative study of online discussion forums. Br J Dermatol. 2016; doi:10.1111/bjd.15130 [Epub ahead of print].

    Google Scholar 

  79. The Drugs and Cosmetics Rules. Ministry of Health and Family Welfare, Government of India. 1945. Available from: http://cdsco.nic.in/html/copy%20of%201.%20dandcact121.pdf. Last accessed on 19 Jan 2017.

  80. Petitioning the Drug Controller of India-Stop indiscriminate OTC sale of topical steroid without prescription, most are Schedule H drugs. Available from: http://www.change.org/p/the-drug-controller-of-india-stop-indiscriminate-otc-sale-of-topicalsteroid-without-prescription-most-are-schedule-h-drugs. Accessed on 21 Jan 2017.

  81. FDCs permitted for continued manufacturing and marketing in respect of the applicants under 18 months policy decision. Central Drugs Standard Control Organization, India. As on 16 Dec 2016. Available from: http://cdsco.nic.in/writereaddata/Final%20Rational%20list%20as%20on%2021_12_2016.pdf. Accessed on 22 Jan 2017.

  82. Bewley A. Expert consensus: time for a change in the way we advise our patients to use corticosteroids. Br J Dermatol. 2008;158:917–20.

    Article  PubMed  Google Scholar 

  83. Long CC, Mills CM, Finlay AY. A practical guide to topical therapy in children. Br J Dermatol. 1998;138:293–6.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, ESIC-PGIMSR, New Delhi, India

    Paschal D’Souza

  2. Consultant Dermatologist, Siliguri, West Bengal, India

    Sanjay K. Rathi

Authors
  1. Paschal D’Souza
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sanjay K. Rathi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paschal D’Souza .

Editor information

Editors and Affiliations

  1. Department of Dermatology, Apollo Gleneagles Hospitals and WIZDERM, Kolkata, India

    Koushik Lahiri

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Singapore Pte Ltd.

About this chapter

Cite this chapter

D’Souza, P., Rathi, S.K. (2018). Rational Use of Topical Corticosteroids. In: Lahiri, K. (eds) A Treatise on Topical Corticosteroids in Dermatology. Springer, Singapore. https://doi.org/10.1007/978-981-10-4609-4_11

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-4609-4_11

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-4608-7

  • Online ISBN: 978-981-10-4609-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation