![]() ![]() ![]() There are no adequate and well-controlled studies in pregnant women on teratogenic effects from topically applied corticosteroids. The more potent corticosteroids have been shown to be teratogenic after dermal application in laboratory animals. Studies to determine mutagenicity with prednisolone and hydrocortisone have revealed negative results.Ĭorticosteroids are generally teratogenic in laboratory animals when administered systemically at relatively low dosage levels. Long-term animal studies have not been performed to evaluate the carcinogenic potential or the effect on fertility of topical corticosteroids. The following tests may be helpful in evaluating the HPA axis suppression:Ĭarcinogenesis, Mutagenesis, and Impairment of Fertility Parents of pediatric patients should be advised not to use tight-fitting diapers or plastic pants on a child being treated in the diaper area, as these garments may constitute occlusive dressings.Patients should report any signs of local adverse reactions, especially under occlusive dressing.The treated skin area should not be bandaged or otherwise covered or wrapped as to be occlusive unless directed by the physician.Patients should be advised not to use this medication for any disorder other than that for which it was prescribed.This medication is to be used as directed by the physician.Patients using topical corticosteroids should receive the following information and instructions: If a favorable response does not occur promptly, the corticosteroid should be discontinued until the infection has been adequately controlled. In the presence of dermatological infections, the use of an appropriate antifungal or antibacterial agent should be instituted. When used on intertriginous or flexor areas, or on the face, this may occur even with short-term use. If irritation develops, topical corticosteroids should be discontinued and appropriate therapy instituted.Īs with any topical corticosteroid product, prolonged use may produce atrophy of the skin and subcutaneous tissues. Infrequently, signs and symptoms of steroid withdrawal may occur, requiring supplemental systemic corticosteroids.Ĭhildren may absorb proportionally larger amounts of topical corticosteroids and thus be more susceptible to systemic toxicity (see 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. 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.Ĭonditions 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. 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. ![]() Once absorbed through the skin, topical corticosteroids are handled through pharmacokinetic pathways similar to systemically administered corticosteroids.Ĭorticosteroids are bound to plasma proteins in varying degrees. Thus, occlusive dressings may be a valuable therapeutic adjunct for treatment of resistant dermatoses (see 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. ![]() There is some evidence to suggest that a recognizable correlation exists between vasoconstrictor potency and therapeutic efficacy in man. Various laboratory methods, including vasoconstrictor assays, are used to compare and predict potencies and/or clinical efficacies of the topical corticosteroids. The mechanism of anti-inflammatory activity of the topical corticosteroids is unclear. Topical corticosteroids share anti-inflammatory, anti-pruritic and vasoconstrictive actions. ![]()
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